EMQ practice - Pulses

• Slow rising pulse, narrow pulse pressure, heaving apex beat and fourth heart sound
• Aortic stenosis
• Other presenting symptoms include angina, shortness of breath, dizziness and syncope on exertion
• Collapsing pulse, wide pulse pressure, 'pistol-shot' sound heard over femoral arteries
• Aortic regurgitation
• Corrigan's sign (carotid pulsation), de Musset's sign (head-nodding) and Quincke's sign (capillary pulsations in the nail bed)
• Radiofemoral delay in a patient with hypertension
• Coarctation of the aorta
• Twice as common in men
• Aorta narrowed
• Turner's syndrome association (45XO)
• Narrowed aorta can cause formation of collateral arterial circulation which leads to erosion of undersurfaces of ribs, giving rise to notched ribs on chest radiograph
• Pulses paradoxus, jugular venous pressure (JVP) rises on inspiration, heart sounds muffled
• Cardiac tamponade
• Beck's triad
• Pulses paradoxus (falling BP)
• Rising JVP on inspiration
• Muffled heart sounds
• Bounding pulse in a patient who is short of breath
• Acute CO2 retention
• Acute rather than chronic CO2 retention.
• Mechanism involves reflex vasodilatation to provide adequate tissue perfusion, and hence may be seen in sepsis