THE HAeMODYNAMIC IMPLICATIONS OF THE BISFERIENS PULSE

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Abstract
A bisferiens carotid arterial displacement pulse recorded in 10 patients with severe aortic valvular disease. The Braunwald test indicated that moderately severe, severe, or gross aortic regurgitation was present in each. The absence of a peak systolic aortic pressure gradient in certain cases, particularly in those with the most severe regurgitation, suggested their freedom from an element of stenosis. The anacrotic wave and the peak of the aortic pressure pulse were found to coincide with the percussion and the tidal waves of the simultaneously recorded carotid arterial displacement curves. It is suggested that amplitude of the peak of the anacrotic wave is proportional to the rate of change of momentum of the ejected blood, and that the amplitude of the corresponding percussion wave of displacement is modified by the distensibility of the artery. The depth and shape of the trough between the 2 peaks is thought to depend upon the magnitude and slope of the 2 waves rather than upon a Venturi effect. It is suggested that the condition of the arterial wall, the diastolic blood pressure, and the stroke volume can influence the pulse sufficiently to preclude its use as a simple guide to the nature of the aortic valve lesion.