A unified mechanism for the water hammer pulse and pulsus bisferiens in severe aortic regurgitation: Insights from wave intensity analysis
- https://doi.org/10.1016/j.artres.2017.12.002How to use a DOI?
- Pulsatile hemodynamics, Arterial tonometry, Aortic regurgitation, Water hammer pulse, Pulsus bisferiens, Physical exam
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.
- © 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 -