The dicrotic arterial pulse.

SUMMARY The study consisted of observations on nine male patients with palpable dicrotic carotid pulses. Average patient age was 37 years. All had advanced myocardial failure as evidenced by cardiomegaly and the presence of prominent atrial and ventricular diastolic gallop sounds. Most of these patients were diagnosed as having primary myocardial disease. The indirect carotid pulse was characterized by a single systolic wave, a low dicrotic notch, and a large dicrotic wave. The direct brachial arterial pressure pulse had a similar configuration with a shortened ejection time index. The hemodynamic data on these patients was characterized by low cardiac output, low stroke volume, elevated pulmonary arterial wedge pressures, and high total systemic resistance. From these observations we conclude that the presence of a marked dicrotic pulse in afebrile patients at rest may indicate severe functional impairment of the myocardium. Additional Indexing Words: Dicrotic notch Dicrotic wave Primary myocardial disease Hemodynan THE dicrotic arterial pulse is characterized by two pulsations with each cardiac cycle; the second is due to an accentuated dicrotic wave (fig. 1). Paul Wood wrote, ".. . the dicrotic pulse is encountered chiefly in patients sick with fever such as typhoid; the peripheral resistance is low, the arteries are lax, and the cardiac output probably normal."' During the past 3 years we have observed a number of patients with a palpable dicrotic arterial pulse. None of them were febrile. It was our clinical impression that these patients had severe impairment of myocardial function. Accordingly, nine of these patients were assessed. Peripheral vascular resistance Methods Each of the nine male patients studied had a dicrotic carotid pulse that was readily palpable. They ranged in age from 29 to 48 years with an average age of 37 years. Seven had primary myocardial disease, one (Z.C.) had advanced hypertensive cardiovascular disease, and one (C.R.) had coronary artery disease with a large ventricular aneurysm. Two of the patients (Z.C. and H.M.) had associated pulmonary emboli. All patients had cardiomegaly by physical and roentgenographic examination. All had both atrial and ventricular, or summation diastolic gallop sounds on auscultation and phonocardiograms; none had cardiac murmurs. All were in normal sinus rhythm. Controls for the indirect carotid pulse recordings were obtained from nine normal male subjects who ranged in age from 25 to 38 years with an average age of 29 years. Controls for the hemodynamic measurements and direct brachial arterial tracings were obtained from …