Understanding abnormal arterial waveforms is crucial in diagnosing various cardiovascular conditions. These waveforms, visualized through arterial pressure tracings, provide insight into the mechanical performance of the heart and the vascular system. Here are some common abnormal arterial waveforms:
Pulsus bisferiens has two distinct systolic peaks (or the second in early diastole) and is associated with aortic insufficiency (AI) and hypertrophic obstructive cardiomyopathy (HOCM). In AI, the second peak is due to peripheral reverberation from the regurgitant blood flow. In contrast, in HOCM, the initial ejection (first peak) is followed by dynamic left ventricular outflow tract obstruction, which is ultimately overcome in late systole (second peak).
Pulsus alternans is characterized by alternating strong and weak pulses – a pattern reflecting the left ventricle’s inability to maintain consistent stroke volumes due to severe left ventricular dysfunction.
Pulsus parvus et tardus refers to an arterial pulse that is both weak (parvus) and delayed (tardus) in its upstroke. This is most commonly associated with aortic stenosis which restricts blood flow and delays ejection.
Pulsus paradoxus is an exaggerated decrease in systolic blood pressure (>10 mmHg) during inspiration and is associated with cardiac tamponade, constrictive pericarditis, and severe asthma or COPD exacerbations. During inspiration, increased intrathoracic pressure reduces venous return to the left heart, leading to a significant drop in stroke volume and systolic blood pressure, leading to pulsus paradoxus.
