Pulsus Bisferiens

A pulse is a rhythmic wave produced by ventricular contraction during systole. A double pulse noticed during systole in the peripheral pulse is called pulsus bisferiens. This is derived from the Latin word, which means strike twice (bis=twice, ferio=strike). It is also called a biphasic wave. Pulsus bisferiens was described by ancient physicians, including Galen in his work during the second century AD..  Pulsus bisferiens is associated with severe aortic disease accompanied by aortic regurgitation and hypertrophic obstructive cardiomyopathy (HOCM). Providers often confuse this with the dicrotic pulse. The main distinguishing feature of pulsus bisferiens is that two peaks are seen in systole. In contrast, a dicrotic pulse is characterized by one peak in systole and the other in diastole. Dicrotic pulse is seen in the low cardiac output state, sepsis, and cardiac tamponade. Pulsus bisferiens is a single central pulse wave with two peaks separated by a distinct mid-systolic dip. An early component percussion wave results from rapid left ventricular ejection. The late component tidal wave represents a reflected wave from the periphery due to an artery's recoil effect. Medical literature has made many revelations about the pulse way back in the first and second centuries AD. Clinical observations of the double pulse were first made by Galen (circa 129–216 AD) in his work De Pulsibus. Mahomed (1872) was the first to describe the terms percussion wave and tidal wave. Broadbent, in 1900 noticed pulsus bisferiens in context to aortic valve disease. Bramwell (1937) put forward the theory of the genesis of the abnormal pulse. Fleming described the mechanism of pulsus bisferiens in 1957.