What is pulsus bisferiens ?

Pulsus bisferiens is a high volume double-beating pulse which has single pulse wave with two peaks in systole

.It is best palpated In large arteries like brachial and carotid arteries.

The first lift is due to P wave (percussion wave) and the second lift is due to T or tidal wave.

It is said that if the P>T. then AI>AS  

and if the T>P. usually AS>AI.
AS-Aortic stenosis
AR-Aortic regugitation

So this will help us to determine the dominant lesion in valve

Pulsus bisferiens is commonly found in.

• Combined AS and Al (commonest).
• Isolated Al.
• IHSS.

What is the pathophysiology of Pulses bisferiens?

This is due to the 'ventury effect' within the left ventricle

Another view explains that the dip in the pulse is felt due to energy dissipation in the productlon of a loud systolic murmur of AS. .

Pulses bisferiens is better felt over the proximal vessels like Carotid and brachial artery.

How to elicit the bisferiens pulse?

• With your fingers, try to press and occlude the brachial artery. On slowly releasing the pressure, you may feel the double peaking of the pulse.
• The first component of the pulse is due to large volume of blood ejected in systole and the second component is produced due to elastic recoil in the arteries This is the best reasoning

Three different causes of double-beating pulse are 

• Bisferiens pulse. 
• Anacrotic pulse 
• Dicrotic pulse.