Images in Clinical Medicine
Kim Eagle, M.D., Editor
Pulsus Alternans
N Engl J Med 1996; 334:834March 28, 1996
- Article
Figure 1 Physical examination of two patients with severe left ventricular failure revealed pulsus alternans in the radial pulse. Pulsus alternans is a physical finding characterized by a regular alternation of the force of the arterial pulse. It almost invariably indicates the presence of severe left ventricular systolic dysfunction.
Panel A shows a simultaneous electrocardiogram (ECG), phonocardiogram, and carotid-pulse tracing in a 64-year-old man with an ejection fraction of 15 percent due to dilated cardiomyopathy. Alternating strong and weak beats are seen in the carotid pulse tracing that corresponded to an alternation of approximately 40 mm Hg in the systolic blood pressure. There is also an alternation of the first heart sound on the phonocardiogram, characterized by a more pronounced sound with a strong contraction (S1S) and a less pronounced sound with a weak beat (S1W). This is due to a more rapid increase in left ventricular pressure with the stronger contraction.
Panel B shows a simultaneous ECG and Doppler tracing in a 29-year-old woman with cardiomyopathy related to the acquired immunodeficiency syndrome and an ejection fraction of 10 percent. Marked alternation in aortic flow is present, corresponding to a calculated alternation in the stroke volume of 2.2:1 between the strong and weak beats.
Kim Eagle, M.D.
Karen Cha, B.S.
Rodney H. Falk, M.D.
Boston University Medical Center, Boston, MA 02118- Citing Articles (2)
Citing Articles
1
Bülent B. Menteş, Tugan Tezcaner, Utku Ylmaz, Sezai Leventoğlu, Mehmet Oguz. (2006) Results of Lateral Internal Sphincterotomy for Chronic Anal Fissure With Particular Reference to Quality of Life. Diseases of the Colon & Rectum 49:7, 1045-1051
CrossRef2
Andrew D. Michaels, Amanda E.M. Browne, Paul Varghese, Tony M. Chou. (2000) Intracoronary measurement of pulsus alternans. Catheterization and Cardiovascular Interventions 51:3, 335-338
CrossRef
