PULSES IN AORTIC STENOSIS Usmle Cardiology

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📌 𝐅𝐨𝐥𝐥𝐨𝐰 𝐨𝐧 𝐈𝐧𝐬𝐭𝐚𝐠𝐫𝐚𝐦:- / drgbhanuprakash • 📌𝗝𝗼𝗶𝗻 𝗢𝘂𝗿 𝗧𝗲𝗹𝗲𝗴𝗿𝗮𝗺 𝗖𝗵𝗮𝗻𝗻𝗲𝗹 𝗛𝗲𝗿𝗲:- https://t.me/bhanuprakashdr • 📌𝗦𝘂𝗯𝘀𝗰𝗿𝗶𝗯𝗲 𝗧𝗼 𝗠𝘆 𝗠𝗮𝗶𝗹𝗶𝗻𝗴 𝗟𝗶𝘀𝘁:- https://linktr.ee/DrGBhanuprakash • PULSES IN AORTIC STENOSIS • Characteristic changes in the morphology of the arterial pulse may occur in the presence of fixed left ventricular outflow tract obstruction, particularly valvular aortic stenosis. Careful examination of the arterial pulse provides useful information for the diagnosis and assessment of the severity of aortic stenosis. • Increased resistance to left ventricular ejection due to fixed obstruction reduces the stroke volume, prolongs left ventricular total ejection time, and retards the rate of initial stroke output into the aorta and distal arterial system. This results in a number of changes that can be appreciated with palpation of the carotid pulse: • ●Anacrotic character (anacrotic pulse) – An anacrotic pulse gives the impression of interruption of the upstroke of the carotid pulse. Aortic stenosis is likely to be hemodynamically significant when the anacrotic notch is felt immediately after the onset of the upstroke. When an anacrotic notch occurs very early on the ascending limb of the arterial pulse, it can be appreciated in the radial pulse and suggests moderate to severe aortic stenosis. • ●Delayed upstroke of the ascending limb (pulsus tardus) – A delayed peak and slower upstroke of the carotid pulse suggest a prolonged left ventricular ejection time. The delay can be appreciated by simultaneous palpation of the carotid pulse and auscultation of the interval between S1 and S2 (duration of systole). Normally, the peak of the carotid pulse occurs closer to S1; in the presence of severe aortic stenosis, it is usually closer to S2. In the presence of fixed outflow obstruction, the central aortic pulse demonstrates a progressively slower rise of the ascending limb, a lower anacrotic shoulder, and a peak closer to the incisura as the severity of obstruction increases. • ●Delayed peak. • ●Small amplitude (pulsus parvus) – The amplitude of the pulse decreases with a diminished stroke volume. • ●Shudder (thrill) on the ascending limb – A thrill (carotid shudder) also is frequently palpable on the ascending limb of the pulse. • The diagnosis and severity of aortic stenosis should not be determined by changes in the carotid pulse configuration alone. The auscultatory findings of aortic stenosis and evidence for left ventricular hypertrophy should be sought. • The carotid arteries may become rigid and less compliant in older adult patients due to arteriosclerosis. The usual changes in the carotid pulse due to aortic stenosis are modified in this situation, due to an increase in pulse wave velocity as a function of increased arterial stiffness. This may lead to an enhancement of pulse wave reflections which can augment the carotid upstroke and mask the findings of aortic stenosis, particularly the amplitude, which may not decrease even in the presence of severe aortic stenosis. • #pulsesinaorticstenosis #aorticstenosis #cardiology #murmurinaorticstenosis #aorticstenosismurmur #murmurs #pulseinaorticstenosis

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