Saudi Journal of Anaesthesia

LETTER TO EDITOR
Year
: 2014  |  Volume : 8  |  Issue : 2  |  Page : 306-

Pulsus alternans: Real and pseudo


Monish S Raut, Arun Maheshwari 
 Department of Cardiac Anesthesia, Dharam Vira Heart Center, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, India

Correspondence Address:
Monish S Raut
Department of Cardiac Anesthesia, Dharam Vira Heart Center, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi - 110 060
India




How to cite this article:
Raut MS, Maheshwari A. Pulsus alternans: Real and pseudo.Saudi J Anaesth 2014;8:306-306


How to cite this URL:
Raut MS, Maheshwari A. Pulsus alternans: Real and pseudo. Saudi J Anaesth [serial online] 2014 [cited 2022 Sep 25 ];8:306-306
Available from: https://www.saudija.org/text.asp?2014/8/2/306/130762


Full Text

 Case 1



An 18-year-old male patient was diagnosed as rheumatic heart disease with severe AR and MR. He was on enalapril as vasodilator preoperatively. Pulse was irregular and collapsing. He was scheduled for valve replacement surgery. Preinduction radial arterial line was inserted. Arterial waveform was peculiar - one greater amplitude peak was followed by one lesser amplitude peak alternately [Figure 1]. This was mimicking pulsus alternans.{Figure 1}

 Case 2



A 60-year-old male patient after coronary artery bypass grafting was having large and small amplitude arterial waveform [Figure 2]. This waveform was appearing as pulsus alternans.

Pulsus alternans is generally seen in left ventricle dysfunction. In case 2, ECG rhythm was bigeminy. Every normal QRS was giving rise to normal arterial pulse wave and every premature ventricular contraction was corresponding to lower amplitude arterial wave. This pattern created pulsus alternans. In case 1, as patient was already vasodilated, there was peripheral run off. So diastolic phase of arterial pulse is prolonged, appearing as 2nd lower amplitude arterial wave. This lower amplitude wave did not correspond to QRS in ECG. Such a waveform can be misdiagnosed as pulsus alternans.{Figure 2}