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What are the abnormal pulses in my patient and what cardiac conditions are they associated with?

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Important information about the patient cardiac status is obtained by physical examination of arterial pulses. A differential diagnosis can be made by inspecting the arterial blood pressure and central/peripheral pulses.

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Patient being evaluated presents with abnormal pulses on physical exam.

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Listen for murmurs, rubs, gallops, location of cardiac impulse, parasternal lifts.

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SWP = Small Weak Pulse.

HKP = HypoKinetic Pulse.

DP = Delayed Pulse.

LBP = Large Bounding Pulse.

DPP = Double Peak Pulse

PWSD = Palpable Waves: 1 in Systole, 1 in Diastole.

AAP = Alteration of Amplitude Pulse.

DPDI = Decreased Pulse or absent During Inspiration.

SULE = Slower Upstroke of Lower Extremity pulse compared to upper extremity/disparity in amplitude.

PP = Pulsus Parvus (dimished left ventricular stroke volume, narrow pulse pressure, increased peripheral vascular resistance)

HV = HyopVolemia

LVF = Left Ventricular Failure

RC = Restrictive Cardiomyopathy

MS = Mitral Stenosis

PT = Pulses Tardus: aortic stenosis with delayed systolic peak, left ventricular obstruction.

KERKP = HypERKinetic Pulse-increased LV stroke volume, wide pulse pressure, decreased peripheral vascular resistance: AV fi stulas, mitral regurgitation, ventricular septal defect.

BWC = Bisferiens/Water hammer/Corrigan: aortic regurgitation, hypertrophic cardiomyopathy.

DICR = DICRrotic: low stroke volumes, dilated cardiomyopathy.

PALT = Pulsus ALTernans: severe impairment of LV function.

PPAR = Pulsus paradoxus: tamponade, airway obstruction, superior vena cava obstruction.

RFD = RadioFemoral Delay: coarcation of aorta.

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SWP = PP

HKP = HV or LVF or RC or MS

DP = PT

LBP = HERKP

DPP = BWC

PWSD = DICR

AAP = PALT

DPDI = PPAR

SULE = RFD

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The arterial pulse begins when the aortic valve opens and left ventricle contracts. There is a rapid rise called the anacrotic notch; then during isovolumic relaxation, there is a reversal of flow prior to aortic valve closure which is called the incisura.

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Palpate all pulses and note for any differences between them, as well as do simultaneous palpation of pulses on each side of the body.

Palpation of pulses can also give information about heart blocks and irregular rhythms: regular irregular pulses are seen in PAC/PVC, irregular irregular pulses seen in atrial fibrillation.

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  1. Chizner M, ed. Classic Teachings in Clinical Cardiology: A Tribute to W. Proctor Harvey. Cedar Grove, NY: Laennec; 1996.

  2. Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrisons Principles of Internal Medicine. 15th ed. New York, NY: McGraw-Hill; 2007.

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What is the likely heart murmur I hear?

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