Arterial Pulses

The finding of a bifid arterial pulse with a brisk upstroke is consistent with aortic regurgitation, combined aortic regurgitation and mild aortic stenosis and hypertrophic obstructive cardiomyopathy.

In hypertrophic obstructive cardiomyopathy, the brisk upstroke and first peak of the bifid arterial pulse are related to the early ejection of blood from the left ventricle at an enhanced velocity. The brief drop in amplitude in mid systole is associated with the development of left ventricular outflow obstruction. The second peak is due to continued ejection of blood past the area of left ventricular outflow tract obstruction in late systole.

Our patient has hyperkinetic peripheral pulses. Markedly brisk, or hyperkinetic, pulses may occur when there is increased velocity of ejection from the left ventricle and/or increased forward stroke volume.