A patient with low cardiac output is having murmur of mitral regurgitation. CXR and histopathology of Endomyocardial biopsy is shown. Which type of pulse would be present in this case?
**Core Concept**
The patient's condition is characterized by mitral regurgitation, which is a valvular heart disease leading to backward flow of blood from the left ventricle to the left atrium during systole. This condition is associated with a decrease in cardiac output. The presence of a murmur and abnormal findings on CXR and Endomyocardial biopsy suggest that the mitral valve is affected.
**Why the Correct Answer is Right**
The murmur of mitral regurgitation is typically associated with a mid-systolic click, followed by a late systolic murmur. This is due to the sudden opening of the mitral valve, leading to a turbulent flow of blood. The decreased cardiac output in this patient would result in a decreased stroke volume, which in turn would lead to a decreased pulse pressure. The pulse would be described as **pulsus tardus** or **parvus**, characterized by a slow upstroke and a decreased amplitude.
**Why Each Wrong Option is Incorrect**
**Option A:** Pulsus bisferiens is a type of pulse associated with aortic regurgitation, characterized by two peaks in each cardiac cycle.
**Option B:** Pulsus paradoxus is a type of pulse associated with severe asthma or cardiac tamponade, characterized by a significant decrease in pulse pressure during inspiration.
**Option C:** Pulsus bigeminus is a type of pulse associated with premature ventricular contractions, characterized by an irregularly irregular rhythm.
**Clinical Pearl / High-Yield Fact**
In a patient with suspected mitral regurgitation, the presence of a mid-systolic click followed by a late systolic murmur is a classic clinical finding. This is often accompanied by a pulsus tardus or parvus, which is a high-yield fact for examination purposes.
**Correct Answer:** C. Pulsus tardus or parvus is the correct answer in this case, as it is associated with mitral regurgitation and decreased cardiac output.