Dicrotism in heart disease: Correlations with cardiomyopathy, pericardial tamponade, youth, tachycardia, and normotension

Abstract

Dicrotism of the brachial pulse as seen in this laboratory is highly correlated with congestive cardiomyopathy and pericardial tamponade when these diagnoses are made on patients below the age of 40 who have a heart rate over 90 beats per minute (in regular rhythm). When not present otherwise, the phenomenon may be elicited by occlusive pressure at or just distal to the point from which it is being sensed, and under these circumstances age drops out as a major determinant of its occurrence. Observations from the previous literature as well as from this laboratory also indicate that dicrotism probably occurs with much less frequency in the presence of elevated blood pressures. Barner, Willman, and Kaiser's 20 experience during the early period following prosthetic replacement of the regurgitant aortic valve and our own with cardiomyopathy suggest that certain cardiac disease states may be more likely than others to give rise to dicrotism. There is a need for further clarification of this possibility. Such a study should include significant numbers of all types of heart disease, but it should also be done, insofar as is possible, in the presence of all those other factors known to favor dicrotism. Historically the dicrotic pulse appears to have excited the attention of clinicians of the last third of the nineteenth century as a part of the new knowledge obtained from the sphygmograph introduced by Marey in 1863. As the sphygmograph fell into disuse with the appearance of the sphygmomanometer and the string galvanometer, interest in the dicrotic pulse also waned, and it is only now, late in the resurgence of interest in pulses afforded by the introduction of modern electronic transducers, that dicrotism is again presenting itself for study. It should be recognized that many of the factors giving rise to dicrotism were known to writers of this earlier period.