Arterial Waveform Analysis — FFICM MCQ

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ModerateCardiovascular & HaemodynamicsArterial Waveform AnalysisFFICM

A 65-year-old man on ICU has an arterial line in the right radial artery. The arterial waveform shows a dicrotic notch that is positioned unusually low on the descending limb, with a wide pulse pressure and a rapid systolic upstroke. What condition does this waveform pattern most likely represent?

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Correct answer: B — Aortic regurgitation

The arterial waveform in aortic regurgitation (AR) shows characteristic features: (1) wide pulse pressure due to high systolic pressure (from increased stroke volume) and low diastolic pressure (from regurgitant flow back into the LV); (2) rapid systolic upstroke (reflecting high stroke volume ejected into a non-obstructed aorta); (3) low or absent dicrotic notch - the dicrotic notch represents aortic valve closure, and in AR, the incompetent valve fails to close properly, causing the notch to be poorly defined or positioned low on the descending limb. Option A (severe AS) would show a slow systolic upstroke (pulsus tardus), narrow pulse pressure, and a delayed peak (pulsus parvus). Option C (tamponade) would show pulsus paradoxus. Option D - the described waveform is abnormal. Option E would show a narrow pulse pressure with low systolic peak.

Reference: Mark (1998): Atlas of Cardiovascular Monitoring - Arterial Waveform Analysis; McGee (2018): Physical Diagnosis