Pulsus alternans: its therapeutic implications

Pulsus alternans is a pulse pattern in which the beats occur at constant intervals but with the regular alternation of the peak of the pressure pulse. Pulsus alternans frequently indicates heart failure due to disease of the left ventricle and will be seen with increasing frequency as more patients are invasively monitored. This report describes four patients who had pulsus alternans and the interventions that resulted in its disappearance. These cases would seem to support previous findings in experimental animals that the appearance of pulsus alternans may be related to myocardial ischemia. A review of the current concepts on the pathophysiology of pulsus alternans is included.