Pulsus bisferiens is most commonly associated with which valvular pathology?

Pulsus bisferiens is most commonly associated with which valvular pathology?

• A. Aortic regurgitation
• B. Aortic stenosis
• C. Hypertrophic cardiomyopathy
• D. Mitral stenosis

Answer: (A)

Pulsus bisferiens is a double-peaked systolic pulse, meaning two systolic peaks appear with each heart beat. This pattern arises when the arterial pressure waveform contains two forward systolic waves, often due to a large stroke volume combined with rapid runoff in the arterial tree and wave reflections returning during systole. Aortic regurgitation fits this best. In AR, the left ventricle ejects a large amount of blood into a highly compliant aorta, and blood also flows back during diastole, causing a rapid fall in diastolic pressure. The combination of a strong early systolic surge and a subsequent reflected or secondary systolic wave produces two distinct systolic peaks felt at the periphery. The other conditions tend to produce different pulse shapes: aortic stenosis typically shows a slow, delayed upstroke (parvus et tardus) rather than a double peak, mitral stenosis often yields a low-volume, low-pressure pulse, and hypertrophic cardiomyopathy can alter pulse but does not classically present as pulsus bisferiens. Hence the most classic association is aortic regurgitation.

Pulsus bisferiens is a double-peaked systolic pulse, meaning two systolic peaks appear with each heart beat. This pattern arises when the arterial pressure waveform contains two forward systolic waves, often due to a large stroke volume combined with rapid runoff in the arterial tree and wave reflections returning during systole.

Aortic regurgitation fits this best. In AR, the left ventricle ejects a large amount of blood into a highly compliant aorta, and blood also flows back during diastole, causing a rapid fall in diastolic pressure. The combination of a strong early systolic surge and a subsequent reflected or secondary systolic wave produces two distinct systolic peaks felt at the periphery.

The other conditions tend to produce different pulse shapes: aortic stenosis typically shows a slow, delayed upstroke (parvus et tardus) rather than a double peak, mitral stenosis often yields a low-volume, low-pressure pulse, and hypertrophic cardiomyopathy can alter pulse but does not classically present as pulsus bisferiens. Hence the most classic association is aortic regurgitation.