Abnormalities of carotid waveform


Parts of a normal carotid waveform:

It has 4 parts:

  1. Percussion wave: Pressure transmission to carotids before blood reaches carotids
  2. Tidal wave: Blood reaching the carotids: Indicates cardiac output
  3. Dicrotic notch: Closure of semilunar valve
  4. Dicrotic wave: Due to back pressure from small vessels: Indicates peripheral vascular resistance (PVR).

Normal waveform:


Parvus et tardus:

  • Parvus = Low amplitude
  • et tardus = Late peak
  • Seen in severe AS.

Pulsus bisferiens:

  • 2 systolic peaks of equal amplitude
  • Seen in severe AR.


  • 2 systolic peaks
  • The second peak has lower amplitude than first one.

Dicrotic pulse:

  • 2 peaks: one at systole and the other at diastole
  • May occur in shock or severe sepsis.

Pulsus alternans:

  • The systolic pressure varies from beat-to-beat independently of the respiratory cycle
  • Sinus rhythm is maintained
  • Seen in severe LV systolic dysfunction.

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