Pulsus bisferiens

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

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


Pulsus bisferiens.jpg

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


Hypertrophic Cardiomyopathy

Double-peak pulse.jpg

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 bisferiens or a "spike and dome pattern" to the carotid pulse.

Causes Of Pulsus Bisferiens


Pulsus bisferiens classically detected in patients with mixed aortic insufficiency and aortic stenosis, but it may also be found in isolated severe aortic insufficiency, and hypertrophic obstructive cardiomyopathy.

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Pulsus bisferiens in itself is not a life threatening condition, but in most of cases it indicate aortic insufficiency, and further investigations should be done.

Common Causes

The most common cause of pulsus bisferiens is sever aortic insufficiency , other causes include:

Causes by Organ System

Cardiovascular Sever aortic insufficiency, aortic valve regurgitation Mixed with aortic stenosis, hypertrophic obstructive cardiomyopathy
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug and Toxin Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic [No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying cause
Infectious Disease No underlying causes
Musculoskeletal / Ortho No underlying causes
Neurologic No underlying cause
Nutritional / Metabolic No underlying cause
Obstetric/Gynecologic No underlying cause
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity [No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

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