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1. AF - pulse varies in rate + amplitude, due to irregular ventricular filling. Exhibits pulse deficit (HR by auscultation > radial pulse).
2. Sinus arrhythmia - HR increases with inspiration, decreases with expiration.
3. Frequent ectopics - ventricular vs. atrial. Bigeminy (every 2 nd beat is an ctopic) vs. trigeminy (every 3 rd beat is an ectopic).
4. Radio-radial delay - subclavian artery stenosis, thoracic aortic dissection, occlusion by thrombus/aneurysm.
5. Radio-femoral delay (Brachiofemoral delay) - aortic coarctation (congenital narrowing of the aortic isthmus at the level of the ductus arteriosus joining the descending aorta).
6. Water-hammer/collapsing pulse (Pulsus parvus et tardus) - aortic coarctation.
7. Pulsus paradoxus - decreased pulse amplitude with inspiration, drop of SBP > 10mmHg on inspiration.
8. Pulsus alternans - varying pulse pressure with a regular HR, seen with severely depressed systolic function.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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