Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-18T01:12:43.106Z Has data issue: false hasContentIssue false
  • English
  • Français

Pulsus alternans in a child with dilated cardiomyopathy

Published online by Cambridge University Press:  14 December 2017

Hasti Sanandajifar  and
Sarosh P. Batlivala
Hasti Sanandajifar
Affiliation:
Division of Pediatric Cardiology, University of Mississippi Medical Center, Jackson, Mississippi, United States of America Children’s Heart Center, Blair E. Batson Hospital for Children, Jackson, Mississippi, United States of America
Sarosh P. Batlivala*
Affiliation:
Division of Pediatric Cardiology, University of Mississippi Medical Center, Jackson, Mississippi, United States of America Children’s Heart Center, Blair E. Batson Hospital for Children, Jackson, Mississippi, United States of America
*
Correspondence to: S. P. Batlivala, MD, Division of Pediatric Cardiology, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, United States of America. Tel: +601 984 5250; Fax: +601 984 5283; E-mail: sbatlivala@umc.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

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. Pulsus alternans is an infrequent, complex pathophysiologic sign often associated with severe heart failure. The mechanisms are incompletely understood, but theorised aetiologies include beat-to-beat changes in left ventricular loading conditions, variations in myocardial oxygen supply/demand, and alternations in myocardial contractility. Recognition of pulsus alternans is important as it provides significant clinical information, may suggest suboptimal medical management, and may be the first warning sign of severe cardiac dysfunction.

Keywords

Cardiomyopathyheart failureechocardiography
Type
Brief Report
Information
Cardiology in the Young , Volume 28 , Issue 3 , March 2018 , pp. 479 - 481
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Harris, LC, Nghiem, QX, Schreiber, MH, Wallace, JM. Severe pulsus alternans associated with primary myocardial disease in children. Observations on clinical features, hemodynamic findings. Mechanisms and prognosis. Circulation 1966; 34: 948–961.CrossRefGoogle ScholarPubMed
2. Weber, M. Pulsus alternans. A case study. Crit Care Nurse 2003; 23: 51–54.CrossRefGoogle ScholarPubMed
3. Cooper, T, Braunwald, E, Morrow, AG. Pulsus alternans in aortic stenosis; hemodynamic observations in 50 patients studied by left heart catheterization. Circulation. 1958; 18: 64–70.CrossRefGoogle ScholarPubMed
4. Cohn, KE, Sandler, H, Hancock, EW. Mechanisms of pulsus alternans. Circulation. 1967; 36: 372–380.CrossRefGoogle ScholarPubMed
5. Edwards, P, Cohen, GI. Both diastolic and systolic function alternate in pulsus alternans: a case report and review. J Am Soc Echocardiogr 2003; 16: 695–697.Google Scholar
6. Hess, OM, Surber, EP, Ritter, M, Krayenbuehl, HP. Pulsus alternans: its influence on systolic and diastolic function in aortic valve disease. J Am Coll Cardiol 1984; 4: 1–7.Google Scholar
7. Surawicz, B, Fisch, C. Cardiac alternans: diverse mechanisms and clinical manifestations. J Am Coll Cardiol 1992; 20: 483–499.CrossRefGoogle ScholarPubMed
8. Mitchell, JH, Sarnoff, SJ, Sonnenblick, EH. The dynamics of pulsus alternans: alternating end-diastolic fiber length as a causative factor. J Clin Invest 1963; 42: 55–63.Google Scholar