The Haemodynamic Implications of the Bisferiens Pulse.

The indirect arterial pulse tracing from a healthy young person normally shows two systolic waves, the percussion wave and the tidal wave (Fig. 1). In hypertension and old age the percussion wave is usually small or absent (Fig. 2). In health, anwmia, and hyperthyroidism (Hancock and Abelmann, 1957), and in patent ductus arteriosus (Fig. 3), the two peaks may be prominent enough to give the pulse a bisferiens character. In aortic valve disease the pulse has a water-hammer quality when the percussion wave is large and sharply peaked, and an anacrotic quality when it is absent or small. The bisferiens pulse is known to occur in aortic valve disease (Bramwell, 1937) (Fig. 4), but there is little agreement about either the nature of the responsible valve lesion or the genesis of the pulse. The purpose of this communication is to describe the nature of the aortic valve lesion in a series of patients with a bisferiens pulse, and to consider the factors that may be responsible for the character of the pulse.