From the Guidelines
Pulsus tardus parvus is a slow-rising, diminished arterial pulse that suggests severe aortic stenosis (AS).
Characteristics of Pulsus Tardus Parvus
- It is characterized by a delayed and reduced pulse upstroke, resulting in a pulse that is both late (tardus) and small (parvus) 1.
- This pulse abnormality is often associated with severe AS, particularly when accompanied by a grade 2/6 midsystolic murmur at the second right intercostal space.
- However, it's worth noting that the typical parvus et tardus pulse may be absent in the elderly, even in those with severe AS, due to the effects of aging on the vasculature 1.
Differential Diagnosis
- Pulsus parvus may also occur with severely reduced cardiac output from any cause, making it essential to consider other factors in the differential diagnosis of left ventricular outflow tract obstruction, as listed in Table 3 of the guidelines 2, 3.
- A comprehensive evaluation, including echocardiography, may be necessary to distinguish between different causes of murmurs and to assess the severity of AS or other valvular diseases.
Clinical Significance
- The presence of pulsus tardus parvus is a significant finding that warrants further investigation, as it may indicate severe AS or other underlying cardiac conditions that require prompt attention and management 4.
From the Research
Definition of Pulsus Tardus Parvus
- Pulsus tardus parvus is a clinical finding characterized by a small, weak pulse with a delayed systolic peak 5, 6, 7.
- It is often associated with aortic stenosis, a condition where the aortic valve becomes narrowed, obstructing blood flow from the heart to the rest of the body 5, 6, 7.
Characteristics of Pulsus Tardus Parvus
- The pulse is small and weak, indicating reduced blood flow 5, 6.
- The systolic peak is delayed, resulting in a prolonged time to reach maximum blood pressure 5, 8.
- The condition can be detected using Doppler ultrasound, which shows a characteristic tardus-parvus waveform in affected arteries 8, 7, 9.
Clinical Significance of Pulsus Tardus Parvus
- Pulsus tardus parvus is a diagnostic sign for severe aortic stenosis, with a high sensitivity and specificity 5, 6, 7.
- It can also be associated with other conditions, such as aortic coarctation, where the aorta is narrowed 9.
- The presence of pulsus tardus parvus can indicate the need for further diagnostic testing, such as echocardiography or aortography, to confirm the underlying condition 6, 7, 9.