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Pulsus Alternans


Presentation

  • This case illustrates that pulsus alternans can be present with diastolic dysfunction of the left ventricle in the absence of systolic dysfunction.[ncbi.nlm.nih.gov]
  • A previously healthy 21-month-old presented with new-onset dilated cardiomyopathy. Evaluation noted pulsus alternans, with beat-to-beat alternations in aortic pulse wave amplitude, both clinically and on diagnostic studies.[ncbi.nlm.nih.gov]
  • We present a case of a patient with severe heart failure, and systolic and diastolic pulsus alternans. This case may help clarify the mechanism of pulsus alternans.[ncbi.nlm.nih.gov]
  • A 56-year-old man presented with severe aortic valve disease. Pulsus alternans was recorded in the left ventricle, apparently provoked by catheter placement through a stenotic aortic valve.[ncbi.nlm.nih.gov]
  • Figure 1 A 51-year-old woman presented with dyspnea on exertion and cardiomegaly. She had a long-standing history of poorly controlled hypertension.[nejm.org]
Weakness
  • Stress-length relations, derived from resting and postnitroglycerin determinations, revealed higher end-systolic dimensions for weak beats at any level of limiting afterload, suggesting diminished contractile performance of weak beats.[ncbi.nlm.nih.gov]
  • […] pressure was reduced from 24/23/22 mmHg (normal beat) to 5/10/6 mmHg (strong beat) and further to 3/7/4 mmHg (weak beat).[ncbi.nlm.nih.gov]
  • Left ventricular diastolic function was evaluated in nine patients from simultaneous diastolic pressure-volume relations during the strong and weak beats.[ncbi.nlm.nih.gov]
  • Physical examination [ edit ] Begin by palpating the radial or femoral arteries, feeling for a regular rhythm but alternating strong and weak pulses.[en.wikipedia.org]
  • A slight difference was noted in the left ventricular end-diastolic diameters, with the weak beat consistently beginning at a slightly smaller diameter (61 /- 13; mm vs 59 /- 13; p less than 0.05).[ncbi.nlm.nih.gov]
Renal Artery Stenosis
  • We describe a patient with recurrent pulmonary edema, hypertension, bilateral renal artery stenosis, but with normal systolic function. Pulsus alternans was demonstrated in both pulmonary artery, right ventricle, and left ventricle pressures.[ncbi.nlm.nih.gov]
  • artery stenosis ) - Aortic dissection / Aortic aneurysm ( Abdominal aortic aneurysm ) - Aneurysm - Raynaud's phenomenon / Raynaud's disease - Buerger's disease - Vasculitis / Arteritis ( Aortitis ) - Intermittent claudication - Arteriovenous fistula[wikidoc.org]
Intravenous Administration
  • In all three patients, pulsus alternans developed after intravenous administration of the phosphodiesterase inhibitor enoximone.[ncbi.nlm.nih.gov]
Candidiasis
  • الصفحة 20 - Candidiasis of bronchi, trachea, or lungs Candidiasis, esophageal Cervical cancer, invasive* Coccidioidomycosis, disseminated or extrapulmonary Cryptococcosis, extrapulmonary Cryptosporidiosis, chronic intestinal ( 1... ‏[books.google.com]
Vomiting
  • Children's Hospital, Iowa City, Iowa, USA Correspondence to Dr Aditya Badheka, aditya-badheka{at}uiowa.edu Statistics from Altmetric.com heart failure intensive care Description A 15-year-old, previously healthy teenager who had fatigue, shortness of breath, vomiting[casereports.bmj.com]
Liver Dysfunction
  • Glyceryl trinitrate paste should be used with caution and under close supervision in patients with liver dysfunction.[ncbi.nlm.nih.gov]
Jaundice
  • المحتويات Ascites 192 Hepatomegaly 195 Jaundice 196 Hematologic Problems 201 White Blood Cell Abnormalities 213 Bleeding and Clotting Disorders 228 Antiphospholipid Syndrome 242 Renal Electrolyte BloodGas and AcidBase Problems 243 BloodGas and pH Abnormalities[books.google.com]
Low Back Pain
  • Back Pain 309 Neck Pain and Selected Cervical Syndromes 318 Endocrine and Metabolic Problems 321 Hypoglycemia 324 Failure to Mature 329 Amenorrhea 332 Adrenocortical Hyperfunction 339 Adrenocortical Hypofunction Insufficiency 342 Obesity 346 Thyroid[books.google.com]
Neck Pain
  • Pain and Selected Cervical Syndromes 318 Endocrine and Metabolic Problems 321 Hypoglycemia 324 Failure to Mature 329 Amenorrhea 332 Adrenocortical Hyperfunction 339 Adrenocortical Hypofunction Insufficiency 342 Obesity 346 Thyroid Enlargement 349 Hypercalcemia[books.google.com]
Facial Pain
  • Pain 375 Syncope 378 Epilepsy Seizures 383 Dizziness and Vertigo 386 Weakness of Neuromuscular Origin 389 Selected Neurogenic Pain Syndromes 392 Spinal Fluid Findings in Disease 395 Normal Values of Standard Laboratory and Function Tests 401 Subject[books.google.com]
Agitation
  • […] factors) judged to be etiologically related to the disturbance. (2) In the absence of such evidence, an etiologic organic factor can be presumed if the disturbance cannot be accounted for by any nonorganic mental disorder, eg, manic episode accounting for agitation[books.google.com]
Vertigo
  • Hypofunction Insufficiency 342 Obesity 346 Thyroid Enlargement 349 Hypercalcemia 352 Hypocalcemia 356 Hyperlipidemia 359 Neurologic Problems 363 Delirium 368 Dementia 370 Headaches and Facial Pain 375 Syncope 378 Epilepsy Seizures 383 Dizziness and Vertigo[books.google.com]

Workup

  • Henry Harold Friedman Lippincott Williams & Wilkins, ٠١‏/٠١‏/٢٠٠١ - 441 من الصفحات Now in its updated Seventh Edition, this popular Spiral(R) Manual is a step-by-step guide to the diagnostic workup of 75 of the most common clinical problems in internal[books.google.com]
Treponema Pallidum
  • pallidum immobilization or fluorescent treponemal antibody absorption test An abnormal titer of antinuclear antibody by immunofluorescence or an equivalent assay at any point in time and in the absence of drugs known to be associated with "druginduced[books.google.com]
Mycobacterium Avium Complex
  • الصفحة 20 - Mycobacterium avium complex or M. kansasii, disseminated or extrapulmonary Mycobacterium tuberculosis, any site (pulmonary or extrapulmonary) Mycobacterium, other species or unidentified species, disseminated or extrapulmonary Pneumocystis[books.google.com]
Complete Left Bundle Branch Block
  • The observations documented the profound depressant hemodynamic effect of complete left bundle branch block in the setting of minimal systolic left ventricular function.[ncbi.nlm.nih.gov]
Prominent A-Wave
  • The rapid upstroke and prominent percussion wave result from rapid left ventricular ejection into the aorta during early systole.[de.slideshare.net]

Treatment

  • Both mechanical and electrical alternans disappeared with afterload reduction by nitroprusside treatment.[ncbi.nlm.nih.gov]
  • This report may be relevant to the currently accepted concepts of afterload reduction in the treatment of chronic congestive heart failure.[ncbi.nlm.nih.gov]
  • Most diseases that cause true pulses alternans do not require surgical treatment. Pulmonary embolectomy may be required for unresolved large pulmonary emboli.[medigoo.com]
  • الصفحة 24 - Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). ‏ الصفحة 134 - Sacks FM, Pfeffer MA, Moye LA et al.[books.google.com]
  • This edition has new chapters on impact and treatment of comorbidities, prevention of sudden cardiac death, rationale for use of anticoagulants, ultrafiltration, use of mechanical devices, and gene and cell therapy.[books.google.com]

Prognosis

  • Specialty Cardiology Pulsus alternans is a physical finding with arterial pulse waveform showing alternating strong and weak beats. [1] It is almost always indicative of left ventricular systolic impairment, and carries a poor prognosis.[en.wikipedia.org]
  • […] pulse pressure heights–eg, every other beat; sustained PA is associated with severely depressed left ventricular function, accompanied by an altered blood flow in the aorta, left ventricular and systolic pressures, and often a 3 rd ventricular sound Prognosis[medical-dictionary.thefreedictionary.com]
  • Mechanisms and prognosis . Circulation 1966 ; 34 : 948 – 961 . 2. Weber , M . Pulsus alternans. A case study . Crit Care Nurse 2003 ; 23 : 51 – 54 . 3. Cooper , T , Braunwald , E , Morrow , AG .[cambridge.org]
  • Regardless of the underlying physiology, the significance of pulsus alternans as a harbinger of severe ventricular dysfunction and poor prognosis has been recognized and unquestioned since its description.[swjpcc.com]

Etiology

  • الصفحة 372 - Either (1) or (2): (1) Evidence from the history, physical examination, or laboratory tests of a specific organic factor (or factors) judged to be etiologically related to the disturbance. (2) In the absence of such evidence, an etiologic[books.google.com]
  • Hypertrophic cardiomyopathy Alcoholic cardiomyopathy Congestive heart failure Acute PE Following cardiac resuscitation During exercise tests Acute mental stress During PTCA Subarachnoid Hemorrhage T-Wave Alternans Etiology Congenital long QT syndrome[mdnxs.com]
  • Etiology • Familial in 55% of cases with autosomal dominant transmission • Mutations in one of 4 genes encoding proteins of cardiac sarcomere account for majority of familial cases • Most mutations novel (not useful for screening yet) Question 21 - What[medstudentlc.com]

Epidemiology

  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.com]
Sex distribution
Age distribution

Pathophysiology

  • A review of the current concepts on the pathophysiology of pulsus alternans is included.[ncbi.nlm.nih.gov]
  • Pulsus alternans is an infrequent, complex pathophysiologic sign often associated with severe heart failure.[ncbi.nlm.nih.gov]
  • Pathophysiology [ edit ] One explanation is that in left ventricular dysfunction, the ejection fraction will decrease significantly, causing reduction in stroke volume, hence causing an increase in end-diastolic volume.[en.wikipedia.org]
  • […] heart hemodynamics Aortic and pulmonary balloon valvuloplasty Coronary hemodynamics for angioplasty and stenting Hemodynamic evaluation of stenotic bioprosthetic mitral valves Evaluation of hypertrophic obstructive cardiomyopathies Understanding cardiac pathophysiology[books.google.de]

Prevention

  • Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. ‏[books.google.com]
  • This edition has new chapters on impact and treatment of comorbidities, prevention of sudden cardiac death, rationale for use of anticoagulants, ultrafiltration, use of mechanical devices, and gene and cell therapy.[books.google.com]
  • This mechanism prevents an increase in the venous pressure during an increase in circulating blood volume. The second physiological action that may be the cause of pulsus alternans is the alteration in cellular handling of calcium.[medigoo.com]
  • All of these effects may be important in preventing or abolishing mechanical alternans.[doi.org]
  • This can be prevented by simultaneously palpating the radial pulse on the arm in which blood pressure is measured. References: [3] [4] Pulses A pulse wave is produced by ventricular contraction during systole .[amboss.com]

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