10 mmHg with inspiration.# Pericardial effusion# Pericardial temponade# Pulmonary embolism (massive)# SVC obstruction# Hemorrhagic shock# Severe obstructive lung disease# Tension pneumothorax.Pulsus bigeminusRegular alteration of pressure pulse amplitude, but it is caused by a premature ventricular contraction that follows each regular beat.PVCsPulsus alternansRegular alteration of pressure pulse amplitude, despite regular rhythm, (defined by beat-to-beat variability of pulse amplitude. And is present only when every other phase 1 Korotkoff sound is audible as the cuff pressure is lowered slowly, typically in a patient with a regular heart rhythm and independent of the respiratory cycle)# LVF/ severe left ventricular systolic heart failure# PAT after premature beatsPulsus bisferiens OR Bifid pulse (percussion & tidal wave)Two systolic peaks (MH 2006).A bifid pulse is easily appreciated in patients on intra-aortic balloon counterpulsation (IABP), in whom the second pulse is diastolic in timing.Advanced AR /HOCM (A bifid pulse described in patients with HOCM, with in scription of percussion and tidal waves)Dicrotic pulse2 palpable waves, 1 in systole 1 in diastoleDCMPulsus parvus (hypokinetic)Small weak pulseA weak and delayed pulse (pulsus parvus et tardus) defines severe aortic stenosis (AS).# LVF,# MS,# Restrictive pericardial diseasePulsus tardusDelayed systolic peak# ASHyperkinetic # CHB,# Anemia,# Fever,# Exercise,# HyperthyroidismAnacrotic pulseA slow, notched, or interrupted upstroke (with a thrill or shudder).Some patients with ASCorrigan's or water- hammer pulse)The carotid upstroke has a sharp rise and rapid fall-off.Chronic severe ARBounding pulse # VSD,# Chronic AR# Ruptured sinus of Valsalva# MR,# HypertensionAlso remember:">