Pulsus bisferiens

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Bisferious pulse, biphasic pulse, spike and dome pattern

Overview

Pulsus bisferiens is a sign where, on palpation of the pulse, a double peak in the aortic waveform is observed with each cardiac cycle.

Bisferious means striking twice. Therefore, pulsus bisferiens is a type of aortic waveform which has two systolic peaks separated by distinct mid-systolic dip

Pathophysiology

Hypertrophic Cardiomyopathy

Pulsus bisferiens is due to systolic anterior motion (SAM) of the mitral valve. Because the mitral valve leaflet doesn't get pulled into the left ventricular outflow tract (LVOT) until after the aortic valve opens, the initial upstroke of the arterial pulse pressure will be normal. When the mitral valve leaflet gets pushed into the LVOT, the arterial pulse will momentarily collapse and will later be followed by a second rise in the pulse pressure, as the left ventricular pressure overcomes the increased obstruction caused by the SAM of the mitral valve. This can be seen on the physical examination as a double tap upon palpation of the apical impulse and as a double pulsation upon palpation of the carotid pulse, known as pulsus bisferiensor a "spike and dome pattern" to the carotid pulse.

Differential Diagnosis Of Causes Of Pulsus Bisferiens

• Classically, it is detected in patients with mixed aortic insufficiency and aortic stenosis

• It may also be found in:

• Isolated but severe aortic insufficiency
• Hypertrophic obstructive cardiomyopathy

Related chapters

• Hypertrophic cardiomyopathy
• Aortic regurgitation