| Written by Dr.Md.Redwanul Huq (Masum) |
| Saturday, 03 March 2012 05:58 |
Causes of abnormal pulses:
(Normal pulse is known as catacrotic pulse)
Regularly irregular pulse:
Atrial flutter
Single & unifocal ventricular extrasystole.
Irregularly irregular pulse:
Atrial fibrillation
Multiple & multifocal ventricular extrasystole.
Pulsus bisferiens (Double peak):
Here the pulse has slow upstroke & rapid downstroke.
-Found in aortic stenosis concomitant with aortic regurgitation.
Pulsus alternans (Alternating high & low volume pulse):
– Found in left ventricular failure.
Pulsus bigeminy:
Here a normal pulse is followed by an immature pulse due to extrasystole.
– Found in digitalis toxicity.
Collapsing pulse (high volume pulse):
Here the pulse has rapid upstroke & rapid down stroke with normal baseline.
Causes are-
1) Aortic regurgitation
2) Aortico- pulmonary fistula
3) Arterio venous fistula
4) Patent ductus- arteriosus
5) Thyrotoxicosis
6) Anemia
7) Fever
8) Beri-beri
9) Paget’s bone disease.
Anacrotic pulse (Low volume pulse):
Here the pulse has slow upstroke & normal down stroke.
– Found in aortic stenosis.
Pulsus paradoxus:
Here pulse volume increases with expiration & vice versa.
Causes are-
1) Constrictive pericarditis
2) Pericardial effusion
3) Severe acute bronchial asthma.
Pulsus deficit:
It is the difference between heart rate & pulse rate.
-Found in atrial fibrillation.
Causes of Atrial fibrillation:
1) IHD
2) Mitral valve disease
3) Hypertension
4) Thyrotoxicosis
5) Pulmonary embolism.
Causes of bradycardia:
Sinus bradycardia:
Physiological causes:
1) Athletes
2) Sleep.
Pathological cause:
1) Increased intracranial pressure
2) Obstructive jaundice
3) Hypothermia
4) Hypothyroidism
5) Drugs: e.g. Digoxin, Beta blockers, Verapamil.
Non-Sinus bradycardia:
2° & 3° Heart block.
Causes of cardiomegaly:
Causes of cardiomegaly are given below-
a) Dilated cardiomyopathy
b) Multiple valvular heart disease (except in only MS)
c) IHD
d) Congenital Heart diseases
e) Beri beri.
Causes of disproportionate tachycardia:
(Disproportionate tachycardia means heart rate is more in relation to body temperature)
Viral myocarditis.
Causes of epigastric pulsation–
1) Lean & thin person
2) Aortic aneurysm
3) Tricuspid regurgitation
4) RVH.
Causes of impalpable apex beat:
1) Obesity
2) Position of the apex behind the rib
3) Pericardial effusion
4) Dextrocardia
5) Due to breast
6) Emphysema.
Causes of low-volume pulse:
1. Hypovolemia- due to diarrhea, vomiting
2. Left ventricular failure
3) Aortic stenosis
4) Mitral stenosis.
Causes of loud 1st heart sound:
a) Mitral stenosis
b) Hyper dynamic circulation
c) Tachycardia.
Causes of soft 1st heart sound:
b) Pericardial effusion
c) Calcified mitral valve.
Cause of MS:
Causes of raised JVP:
Non-pulsatile rise:
1) CCF (Congestive cardiac failure)
2) Constrictive pericarditis
3) Pericardial effusion
4) Superior venacaval (SVC) obstruction due to lymphoma or bronchogenic carcinoma
5) Cor-pulmonale.
Pulsatile rise:
1) Hypervolemia due to-
i) Physiological cause: Pregnancy
ii) Pathological causes:(These causes are also responsible for water hammer pulse, collapsing pulse or high volume pulse)
2) Aortic regurgitation
3) Aortico- pulmonary fistula
4) Arterio venous fistula
5) Patent ductus- arteriosus
6) Thyrotoxicosis
7) Anemia
8) Fever
8) Beri-beri
9) Paget’s bone disease.
Causes of relative bradycardia:
(i.e. Relative bradycardia means heart rate is less in relation to body temperature)
2) Dengue fever.
Causes of shifted apex beat:
1) Heart cause : LVH (Left ventricular hypertrophy)
2) Lung Causes:
a) Pushing the apex beat- massive pleural effusion or pneumothorax
b) Pulling the apex beat- Fibrosis or collapse of the lung.
Causes of Systolic murmur in tricuspid area:
a) TR
b) VSD
c) MR.
Causes of tachycardia:
Sinus tachycardia:
Physiological causes:
1) Pregnancy
2) Exercise
3) Emotion
4) Excitement.
Pathological causes:
1) Thyrotoxicosis
2) Fever
3) Anemia
4) Cardiac failure
5) Drugs, e.g. Adrenalin, Atropin.
Non- Sinus tachycardia:
Atrial flutter
Atrial fibrillation
Supra-ventricular tachycardia
Ventricular tachycardia.
