From the Guidelines
Pulsus Parvus et Tardus is a significant clinical finding that indicates severe aortic stenosis (AS) or severely reduced cardiac output from any cause.
Key Points
- The presence of a slow-rising, diminished arterial pulse, also known as pulsus parvus et tardus, suggests severe AS in a patient with a grade 2/6 midsystolic murmur at the second right intercostal space 1.
- This finding is characterized by a delayed and reduced pulse, which is a result of the obstruction to blood flow caused by the stenotic aortic valve.
- However, it's worth noting that pulsus parvus et tardus may be absent in the elderly, even in those with severe AS, due to the effects of aging on the vasculature 1.
- Pulsus parvus can also occur with severely reduced cardiac output from any cause, making it a non-specific finding that requires further evaluation 1.
- The diagnosis of AS and the assessment of its severity should be confirmed using echocardiography, which can provide valuable information on the valve's morphology and function 1.
Clinical Implications
- The presence of pulsus parvus et tardus should prompt a thorough evaluation of the patient's cardiac function and anatomy to determine the underlying cause of the finding.
- In patients with suspected AS, echocardiography should be performed to confirm the diagnosis and assess the severity of the disease 1.
- The recognition of aortic valve sclerosis may prompt the initiation of more aggressive programs of coronary heart disease prevention 1.
From the Research
Significance of Pulsus Parvus et Tardus
- Pulsus parvus et tardus is a clinical finding characterized by a small, weak pulse with a delayed systolic peak, often associated with aortic stenosis (AS) 2, 3, 4.
- The presence of pulsus parvus et tardus can be an indicator of severe AS, with studies showing a higher frequency of this finding in patients with moderate or severe AS compared to those with mild AS 3, 4.
- The diagnostic value of pulsus parvus et tardus can be limited by factors such as left ventricular systolic dysfunction, which can also contribute to the occurrence of pulsus tardus 5.
- Doppler flow characteristics, including pulsus tardus et parvus, can be highly predictive of aortic valve disease, particularly when detected in the common carotid artery (CCA) and internal carotid artery (ICA) 4.
Clinical Implications
- Pulsus parvus et tardus can be a useful diagnostic sign for severe AS, but its validity as a diagnostic sign is not universally confirmed 2.
- The presence of pulsus parvus et tardus should be considered in conjunction with other clinical and echocardiographic findings to diagnose AS 3, 4.
- The consideration of Doppler flow characteristics, including pulsus tardus et parvus, can be useful in streamlining diagnostic and therapeutic measures, particularly in the outpatient setting 4.
Pathophysiological Mechanisms
- Pulsus tardus is caused by the compliance of the poststenotic vessel wall in conjunction with the stenosis, which produces the tardus effect by damping the high-frequency components of the arterial waveform 6.
- The occurrence of pulsus tardus can be associated with not only AS severity but also left ventricular systolic dysfunction in AS patients 5.