Abstract

In medicine, pulsus bisferiens, also bisferious pulse or biphasic pulse, is a sign where, on palpation of the pulse, a double peak per cardiac cycle can be appreciated. "Bisferious" means striking twice. Classically, it is detected when aortic insufficiency exists in association with aortic stenosis, but may also be found in isolated but severe aortic insufficiency, and hypertrophic obstructive cardiomyopathy.

Normally, arterial pulses are best felt in radial arteries but character is better assessed in carotid artery. Pulsus bisferiens is best felt in brachial and femoral arteries. Another pulse which can be confused with bisferiens is pulsus alternans which is felt better in peripheral arteries. The first lift is due to "percussion wave"(P) and the second lift is due to tidal wave (T).

- If P>T - AR>AS

- If T>P - AS>AR

Characteristic causes:

1. Aortic regurgitation (AR)

2. Aortic regurgitation with Aortic Stenosis (AR+AS)

3. Hypertrophic cardiomyopathy