Answer 3 Hypertrophic cardiomyopathy. In the setting of hypertrophic cardiomyopathy, a trifid left ventricular impulse may be palpable owing to a forceful presystolic impulse in addition to a midsystolic drop in pressure secondary to the outlet obstruction. This midsystolic drop in pressure causes a bisferious carotid pulse. The carotid pulse is bisferious during systole in patients with this disorder. Click here to return to the questions
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