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Left ventricular diastolic pulsus alternans in hypertrophic cardiomyopathy
T Yamakado1, C Oomichi, M Maeda
1First Department of Internal Medicine, Mie University, Tsu, Japan.
Insights
Pulsus alternans, a beat-to-beat variation in heart contraction strength, was studied in hypertrophic cardiomyopathy. Diastolic pulsus alternans, characterized by abnormal relaxation, persisted despite medication, suggesting it may be independent of systolic pulsus alternans.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Hypertrophic cardiomyopathy (HCM) is a genetic heart muscle disease.
- Pulsus alternans, a beat-to-beat variation in pulse amplitude, is typically associated with systolic dysfunction.
- Left ventricular (LV) diastolic dysfunction is a key feature of HCM.
Observation:
- This study observed diastolic pulsus alternans in a patient with hypertrophic cardiomyopathy.
- Abnormal LV diastolic pressure waveforms showing incomplete relaxation alternated with normal diastolic pressure.
- Systolic pulsus alternans was also present in the patient.
Findings:
- Diastolic pulsus alternans was characterized by persistent declines in LV diastolic pressure into mid-diastole.
- The observed diastolic pulsus alternans was not alleviated by isoproterenol administration.
- This suggests that diastolic pulsus alternans may be an independent phenomenon from systolic pulsus alternans in this context.
Implications:
- The findings challenge the traditional understanding of pulsus alternans solely as a systolic phenomenon.
- Understanding diastolic pulsus alternans in HCM may lead to improved diagnostic and therapeutic strategies.
- Further research is needed to elucidate the mechanisms and clinical significance of diastolic pulsus alternans in HCM.
Abstract:
We examined left ventricular (LV) diastolic pulsus alternans associated with systolic pulsus alternans in a patient with hypertrophic cardiomyopathy. Alternation in abnormal LV diastolic pressure waveforms persistently declining into mid-diastole (incomplete relaxation) and normal diastolic pressure were noted. Diastolic pulsus alternans was not corrected by isoproterenol and may possibly be independent of systolic pulsus alternans.