Respirophasic variation of brachioradial delay in patients with moderate-severe aortic stenosis + bronchospasm is one of my favorite physical findings. It is a great teacher of physiology.
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Under optimal conditions, preload+contractility might be good enough to overcome the tight valve, and expel enough blood and quickly enough, where you feel the brachia and radial pulses at the same time. No brachioradial delay.
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But add in bronchospasm or other cause of increased respiratory effort. Expiratory Valsalva drops preload, and expelled volume/velocity through that AV is more parvus, more tardus for a couple beats. The brachial & radial impulses split like an S2, then come together again.
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