Pulses

Question 1

What is pulsus paradox?

Answer 1

• Greater than the normal (10 mmHg) fall in systolic blood pressure during inspiration → faint or absent pulse in inspiration

Question 2

Where do you get pulsus paradox?

Answer 2

1. Severe asthma
2. Cardiac tamponade

Question 3

Where do you get a slow rising pulse?

Answer 3

Aortic stenosis

Question 4

Where do yo get a collapsing pulse?

Answer 4

1. Aortic regurgitation
2. Patent ductus arteriosus
3. Hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy)

Question 5

Where do you get pulsis alternans?

Answer 5

Severe LVF

Question 6

What is pulsus alternans?

Answer 6

Regular alternation of the force of the arterial pulse

Question 7

What is bisferiens pulse?

Answer 7

‘Double pulse’ - two systolic peaks

Question 8

Where do you get bisferiens pulse?

Answer 8

Mixed aortic valve disease

Question 9

Where do you get a jerky pulse?

Answer 9

Hypertrophic obstructive cardiomyopathy*

*HOCM may occasionally be associated with a bisferiens pulse

Question 10

What can the long saphenous vein be used for?

Answer 10

• This vein may be harvested for bypass surgery
• Removed as treatment for varicose veins with saphenofemoral junction incompetence

Question 11

Describe the course of the long saphenous vein

Answer 11

1. Originates at the 1st digit where the dorsal vein merges with the dorsal venous arch of the foot
2. Passes anterior to the medial malleolus ==> runs up the medial side of the leg
3. At the knee: runs over the posterior border of the medial epicondyle of the femur bone
4. Passes laterally to lie on the anterior surface of the thigh before entering an opening in the fascia lata called the saphenous opening
5. It joins with the femoral vein in the region of the femoral triangle at the saphenofemoral junction

Question 12

What are the tributaries of the saphenous vein?

Answer 12

1. Medial marginal
2. Superficial epigastric
3. Superficial iliac circumflex
4. Superficial external pudendal veins

Question 13

Describe the course of the short saphenous vein

Answer 13

1. Originates at the 5th digit where the dorsal vein merges with the dorsal venous arch of the foot, which attaches to the great saphenous vein.
2. It passes around the lateral aspect of the foot (inferior and posterior to the lateral malleolus) and runs along the posterior aspect of the leg (with the sural nerve)
3. Passes between the heads of the gastrocnemius muscle, and drains into the popliteal vein, approximately at or above the level of the knee joint