Pulsus bisferiens

• Pulse with two systolic peaks
• Most commonly caused by:
  • Aortic valve disease including infective endocarditis, rheumatic heart disease, Marfan syndrome, and bicuspid aortic valve
  • Hypertrophic cardiomyopathy with obstruction
• Occasionally caused by:
  • Severe aortic regurgitation
  • Large patent ductus arteriosus or arteriovenous fistula
  • Significant mitral valve prolapse
  • Rarely in normal people with a hyperdynamic circulatory state