Aetiology
The usualy cause of a bisferiens pulse is combined aortic valve stenosis and regurgitation:
- both conditions must be severe
- the first impulse is the shock wave of a vigorous contraction of a volume-overloaded left ventricle; this is the result of aortic regurgitation
- the second impulse is generated by the prolonged ejection of blood which results from the aortic stenosis
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