Knowing the language of a disease

Palpation of the radial pulse is often one of the first things that doctors do when examining a patient. The pulse is examined for its rate, rhythm and character. The peripheral pulses are also examined to see if they are equally and symmetrically felt. Each of these aspects of the pulse can offer diagnostic clues to the doctor who understands the language of diseases.

Here is an example of how an examination of the pulse allowed one doctor to make a diagnosis that startled his students.

Dr X was told that a particular patient had a heart murmur. He was not allowed to auscultate the patient to determine anything more about the murmur. He was only allowed to palpate the patient's pulse. Thirty seconds after examining the patient's pulse, Dr Sandy said: This patient has aortic regurgitation. His students, new to clinical medicine, were all stunned.
They asked him: How did you correctly diagnose a valve abnormality in the heart by simply feeling the pulse?
Elementary, my dear students, Dr X replied. I noted that the pulse was of a collapsing nature. Only a few conditions are associated with a collapsing pulse and a heart murmur. Aortic regurgitation is one of them.

Do you know what cardiac abnormality to diagnose when:

1. The pulse is of small volume and rises slowly to its peak? This kind of pulse is called the anacrotic pulse.

2. The pulse has two distinct peaks during systole? This kind of pulse is called the bisferiens pulse.

3. The pulse disappears during inspiration? This kind of pulse is called the paradoxical pulse.