Images in Clinical Medicine
Pulsus Alternans
N Engl J Med 1999; 341:955September 23, 1999
- Article
Figure 1 A 51-year-old woman presented with dyspnea on exertion and cardiomegaly. She had a long-standing history of poorly controlled hypertension. Physical examination revealed an elevated jugular venous pressure, clear lungs, a left ventricular S3, and prominent pulsus alternans on examination of her peripheral pulses. Cardiac catheterization revealed normal coronary arteries and severe, global left ventricular systolic dysfunction, with an ejection fraction of 15 percent. Right-sided hemodynamics were consistent with the presence of severe biventricular congestive heart failure. Although pulsus alternans was present before ventriculography, the tracing of the aortic pressure shown here was obtained after ventriculography, at which time pulsus alternans was more prominent. It was also observed in the wave forms of left ventricular, right ventricular, and pulmonary-artery pressure. The regularity of the pulsus alternans was interrupted by a ventricular premature beat (arrow). The mechanism of pulsus alternans is not entirely clear, but it has long been a subject of great interest. Pulsus alternans is attributed to an alteration in the stroke volume with every other cardiac cycle and is typically seen in patients with advanced myocardial disease.
David P. McLaughlin, M.D.
Martha Jefferson Hospital, Charlottesville, VA 22902- Citing Articles (1)
Citing Articles
1
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
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