Pulsus Alternans

Other Names

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Pulsus Alternans

A. Arterial blood pressure tracing showing pulsus alternans with >20mmHg pressure difference in alternate beats. Note the premature ventricular contraction leads to ineffective pulse leading to pulse deficit (arrow), followed by post-extrasystolic potentiation (dashed arrow). B. Simultaneous pulse-wave doppler at the aortic and pulmonary (C) valve showing alternating velocity suggesting stroke volume alternans (biventricular alternans).

Pulsus alternans in a patient with severe left ventricular systolic dysfunction. The systolic pressure varies from beat to beat independently of the respiratory cycle. The rhythm is sinus throughout

• Alternating pulse
• Cardiac alternans
• Mechanical alternans

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Purpose

• To identify alternating strong and weak arterial pulse amplitudes during an otherwise regular cardiac rhythm
• To assess for significant left ventricular systolic dysfunction or advanced heart failure

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Description

• Pulsus alternans is characterized by a regular rhythm with alternating high- and low-amplitude arterial pulses
• It may be detected by palpating a peripheral pulse or during manual blood-pressure measurement
• During cuff deflation, Korotkoff sounds may initially be heard with every other heartbeat and then with every beat as cuff pressure decreases.
• The difference between these two cuff-pressure levels estimates the magnitude of pulsus alternans

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Pathology

• Severe left ventricular systolic dysfunction
• Advanced heart failure
• Dilated cardiomyopathy
• Severe aortic stenosis
• Hypertrophic cardiomyopathy
• Ischemic cardiomyopathy
• Acute myocardial infarction
• Severe systemic hypertension

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Evidence

• Uknown

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See Also

• Cardiology Main
• Physical Exam Cardiology
• Chest Anatomy

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