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Year : 2015  |  Volume : 63  |  Issue : 12  |  Page : 933-934

Comment on: Alternate description of waveform: Pulsus bisferiens

Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH, USA

Date of Web Publication10-Feb-2016

Correspondence Address:
Dr. Katja R Turner
410 West, 10th Avenue, Doan Hall N-411, Columbus, OH 43210
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0301-4738.176034

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How to cite this article:
Turner KR, Otey AJ. Comment on: Alternate description of waveform: Pulsus bisferiens. Indian J Ophthalmol 2015;63:933-4

How to cite this URL:
Turner KR, Otey AJ. Comment on: Alternate description of waveform: Pulsus bisferiens. Indian J Ophthalmol [serial online] 2015 [cited 2020 Nov 26];63:933-4. Available from: https://www.ijo.in/text.asp?2015/63/12/933/176034

Dear Sir,

We read the article written by Kassem et al.[1] in January with great interest. It described the path to diagnosing significant aortic insufficiency starting with abnormal ocular pulse amplitude (OPA) obtained with a dynamic contour tonometer. The OPA waveform obtained showed two peaks instead of one. The abnormal waveform described in this paper shows great resemblance to an arterial waveform described as "pulsus bisferiens." This potential correlation was not mentioned by the authors.

The term "pulsus bisferiens" was described in the context of aortic valve disease by Broadbent and Broadbent in 1900.[2] Fleming described the mechanism of pulsus bisferiens in 1957 in patients with combined aortic stenosis and insufficiency. More recently, Mark published depictions of pulsus bisferiens in his  Atlas More Details of monitoring.[3] As an anesthesiologist frequently using invasive blood pressure monitoring, it is not uncommon to observe "pulsus bisferiens" displayed when taking care of patients with significant aortic insufficiency. We attached two figures demonstrating "pulsus bisferiens" in patients with aortic insufficiency, showing waveform variations. [Figure 1] and [Figure 2].
Figure 1: Example 1 - Arterial waveform with pulsus bisferiens

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Figure 2: Example 2 - Arterial waveform with pulsus bisferiens

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If intraocular pressure closely relates to the arterial pressure, it comes as no surprise that the waveform would resemble an arterial waveform. As the authors are that suggesting OPAs might be used as a screening tool for other diseases, we would suggest thinking of "pulsus bisferiens" when noticing a waveform with two peaks, and direct a further workup toward aortic valve disease.

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  References Top

Kassem JB, Katz SE, Mahmoud AM, Small RH, Raman SV, Roberts CJ. Ocular pressure waveform reflects ventricular bigeminy and aortic insufficiency. Indian J Ophthalmol 2015;63:59-61.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
Broadbent WH, Broadbent JF. Heart Disease. 3rd ed. London: Bailliere, Tindall and Cox; 1900.  Back to cited text no. 2
Mark JB. Atlas of Cardiovascular Monitoring. New York: Churchill Livingstone; 1998. p. 311, 325.3.  Back to cited text no. 3


  [Figure 1], [Figure 2]


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