Pulsus alternans

Pulsus alternans is a physical finding in the cardiac examination characterized by alternations in the force of the arterial pulse in a regular rhythm. It is an indicator of left ventricular systolic impairment and is associated with a poor prognosis.

Definition

Pulsus alternans is defined as a regular rhythm of the pulse with alternating strong and weak beats. It is most commonly detected during manual palpation of the radial artery.

Pathophysiology

The underlying mechanism of pulsus alternans involves changes in the left ventricle's ability to contract. In conditions of left ventricular systolic impairment, the heart's ability to pump blood effectively is compromised. This results in a decrease in stroke volume during each heartbeat, leading to the characteristic alternating pulse pattern.

Clinical Significance

Pulsus alternans is a sign of severe left ventricular systolic dysfunction and is often associated with advanced heart disease, including congestive heart failure, myocardial infarction, and cardiomyopathy. It is also seen in patients with aortic stenosis and hypertension.

Diagnosis

The diagnosis of pulsus alternans is primarily clinical, based on the physical examination of the patient. It can be confirmed by an echocardiogram, which can visualize the alternating contractions of the heart.

Treatment

The treatment of pulsus alternans involves addressing the underlying cause. This may include medications to improve heart function, such as beta-blockers, ACE inhibitors, and diuretics, as well as lifestyle modifications and potentially surgery.

See Also

• Heart failure
• Cardiomyopathy
• Aortic stenosis
• Hypertension

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