Pulsus alternans

An arterial pulse characterized by a regular rhythm with beat-to-beat alternation of strong and weak pulse amplitude, reflecting alternating strong and weak ventricular contractions, most commonly due to severe left ventricular systolic dysfunction.

Causes

• Left ventricular systolic dysfunction

  • Dilated cardiomyopathy

  • Ischemic cardiomyopathy

• Ischemic heart disease

  • Coronary artery disease

  • Myocardial infarction

• Aortic stenosis

• Pulmonary disease

  • Pulmonary embolism

  • Pulmonary hypertension

• Pericardial effusion

• Hypertensive heart disease

• Myocarditis