Part of Springer Nature

Artery Research

Volume 21, Issue C, March 2018, Pages 9 - 12

A unified mechanism for the water hammer pulse and pulsus bisferiens in severe aortic regurgitation: Insights from wave intensity analysis

Authors
Julio A. Chirinosa, b, *, Scott R. Akersb, Jan A. Vierendeelsc, Patrick Segersd
aUniversity of Pennsylvania, Philadelphia, PA, USA
bPhiladelphia VA Medical Center, Philadelphia, PA, USA
cDepartment of Flow, Heat and Combustion Mechanics, Ghent University, Ghent, Belgium
dInstitute Biomedical Technology, Ghent University, Ghent, Belgium
*Corresponding author. South Tower, Rm. 11-138, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, 19104, Philadelphia, PA, USA. Fax: +215 746 7415. E-mail address: Julio.chirinos@uphs.upenn.edu (J.A. Chirinos).
Corresponding Author
Julio A. Chirinos
Received 18 November 2017, Revised 5 December 2017, Accepted 8 December 2017, Available Online 21 December 2017.
DOI
https://doi.org/10.1016/j.artres.2017.12.002How to use a DOI?
Keywords
Pulsatile hemodynamics, Arterial tonometry, Aortic regurgitation, Water hammer pulse, Pulsus bisferiens, Physical exam
Abstract

The carotid bisferiens pulse and the radial water hammer pulse are typical of severe chronic aortic regurgitation. Little is known about the mechanism of these classic cardiovascular signs identified on physical examination. We report the first characterization of these abnormal pulse patterns using wave intensity analysis (WIA) in a patient with severe aortic regurgitation. We demonstrate that an abnormally pronounced forward-traveling mid-systolic suction wave, which immediately followed the initial forward-traveling compression wave from ventricular contraction, explained these pulse patterns. This suction wave likely resulted from blood inertia, arising from a ventricle ejecting a very large stroke volume into a vasodilated arterial tree. Our report demonstrates a novel pulsatile hemodynamic mechanism that unifies the pathogenesis of the bisferiens pulse and the water-hammer pulse in severe aortic regurgitation.

Copyright
© 2017 Association for Research into Arterial Structure and Physiology. Published by Elsevier B.V. All rights reserved.
Open Access
This is an open access article distributed under the CC BY-NC license.

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Journal
Artery Research
Volume-Issue
21 - C
Pages
9 - 12
Publication Date
2017/12
ISSN (Online)
1876-4401
ISSN (Print)
1872-9312
DOI
https://doi.org/10.1016/j.artres.2017.12.002How to use a DOI?
Copyright
© 2017 Association for Research into Arterial Structure and Physiology. Published by Elsevier B.V. All rights reserved.
Open Access
This is an open access article distributed under the CC BY-NC license.

Cite this article

TY  - JOUR
AU  - Julio A. Chirinos
AU  - Scott R. Akers
AU  - Jan A. Vierendeels
AU  - Patrick Segers
PY  - 2017
DA  - 2017/12
TI  - A unified mechanism for the water hammer pulse and pulsus bisferiens in severe aortic regurgitation: Insights from wave intensity analysis
JO  - Artery Research
SP  - 9
EP  - 12
VL  - 21
IS  - C
SN  - 1876-4401
UR  - https://doi.org/10.1016/j.artres.2017.12.002
DO  - https://doi.org/10.1016/j.artres.2017.12.002
ID  - Chirinos2017
ER  -