Pulsus bisferiens
Pulsus bisferiens describes the presence of an exaggerated “double pulsation” in the arterial pulse. While the arterial pulse is normally dicrotic, consisting of a percussion wave and a tidal wave, the individual waves are not typically visible or palpable at the bedside. The pulse looks and feels like a single wave. When the two waves are discernable at the bedside, it is known as pulsus bisferiens. It is most often associated with the combination of aortic stenosis and aortic regurgitation, but is sometimes seen in patients with pure aortic regurgitation.
Patient 1:
This is an older man with an aortic root aneurysm complicated by moderate to severe aortic regurgitation. Notice that there is a “double” flicker of the swab, illustrating a “double pulsation” or bisferiens pulse.
This patient also has a decrescendo diastolic murmur over Erb’s point, Corrigan’s pulse, and a bounding peripheral pulse.