|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 12 | Page : 933-934
Comment on: Alternate description of waveform: Pulsus bisferiens
Katja R Turner, Andrew J Otey
Department of Anesthesiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
|Date of Web Publication||10-Feb-2016|
Dr. Katja R Turner
410 West, 10th Avenue, Doan Hall N-411, Columbus, OH 43210
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Turner KR, Otey AJ. Comment on: Alternate description of waveform: Pulsus bisferiens. Indian J Ophthalmol 2015;63:933-4
We read the article written by Kassem et al. 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. 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. 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].
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|| |
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.
Broadbent WH, Broadbent JF. Heart Disease. 3rd
ed. London: Bailliere, Tindall and Cox; 1900.
Mark JB. Atlas of Cardiovascular Monitoring. New York: Churchill Livingstone; 1998. p. 311, 325.3.
[Figure 1], [Figure 2]