From the Guidelines
Pulsus parvus et tardus is a specific type of abnormal arterial pulse characterized by a weak, diminished amplitude and delayed upstroke, most commonly associated with severe aortic stenosis. This pulse pattern is identified by a slow-rising, diminished arterial pulse, which may be absent in the elderly due to the effects of aging on the vasculature 1. The physical finding occurs because the stenotic valve creates resistance to ejection, causing blood to flow more slowly through the narrowed opening, resulting in reduced force and delayed transmission of the pulse wave.
Key Characteristics
- Weak, diminished amplitude (parvus)
- Delayed upstroke (tardus)
- Slow-rising arterial pulse
- Associated with severe aortic stenosis
- May be absent in the elderly due to vascular changes When feeling for this pulse at the carotid artery, clinicians will notice both the reduced strength and the characteristic slow rise compared to a normal pulse, which typically has a brisk upstroke.
Clinical Significance
This finding is an important clinical sign that should prompt further cardiac evaluation, including echocardiography, as severe aortic stenosis requires monitoring and may eventually need valve replacement 1. Other conditions that can occasionally produce similar pulse characteristics include hypertrophic cardiomyopathy and severe aortic regurgitation with heart failure.
Diagnostic Approach
An echocardiogram to rule in or rule out the presence of significant AS should be obtained, especially in patients with clinical findings suggestive of endocarditis or a history of thromboembolism 1.
From the Research
Definition of Pulsus Parvus et Tardus
- Pulsus parvus et tardus is a medical term that refers to a small, weak pulse with a delayed systolic peak, typically associated with aortic stenosis (AS) 2.
- The condition is characterized by a reduced pulse pressure and a delayed upstroke of the arterial pulse wave, resulting in a "parvus" (small) and "tardus" (late) pulse.
Clinical Significance
- Pulsus parvus et tardus is a well-recognized clinical finding in patients with severe aortic stenosis, and its presence can be an indicator of the severity of the condition 2.
- The diagnostic value of radial arterial pressure curves has been investigated, and while pulsus parvus was not confirmed as a diagnostic sign, pulsus tardus was validated as a diagnostic sign for severe AS 2.
Related Conditions
- Aortic coarctation, a narrowing of the aortic isthmus, can also present with a tardus-parvus Doppler waveform in the renal arteries, suggesting a more distal obstruction 3.
- Severe aortic stenosis can lead to high mortality rates, especially in patients who are not eligible for percutaneous aortic valve replacement (PAVR) or surgical aortic valve replacement 4, 5.
Treatment and Outcomes
- Balloon aortic valvuloplasty (BAV) is a treatment option for patients with severe aortic stenosis, and its outcomes have been studied in various cohorts 5, 6.
- BAV can be used as a bridge to TAVI or surgical aortic valve replacement, and its success and complications have been reported in several studies 5, 6.