Pulse Abnormalities - Differential Diagnosis Algorithm

Unequal/DeIayed:

 • Obstructive arterial disease (ie. Atherosclerosis)

 • Aortic dissection

 • Aortic aneurysm

 • Aortic coarctation

 • Takayasu disease

 • Normal variant

Pulsus Alternans - Variation in pulse amplitude with alternate beats:

 • Left heart failure

Pulsus Paradoxus - Exaggerated inspiratory drop in arterial pressure >10mmHg:

 • Cardiac tamponade

 • AECOPD/ Acute Exacerbation of Asthma

 • Hypovolemic shock

 • Constrictive Pericarditis

 • Restrictive Cardiomyopathy

Aortic Stenosis:

 • Anacrotic

 • Pulsus parvus (small amplitude)

 • Pulsus tardus (delayed/slow upstroke)

Water Hammer Pulse - Rapid upstroke followed by rapid collapse:

 • Aortic regurgitation

 • High output states (ie. Anemia, hypoglycemia)



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