Pulsus alternans: Difference between revisions
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{{CMG}}; {{AE}} [[Varun Kumar]], M.B.B.S. | {{CMG}}; {{AE}} [[Varun Kumar]], M.B.B.S.; {{MM}} | ||
==Overview== | ==Overview== | ||
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===Life Threatening Causes=== | ===Life Threatening Causes=== | ||
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Pulsus alternans in itself is not a life threatening condition, but in most of cases it indicate [[ | Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Pulsus alternans in itself is not a life threatening condition, but in most of cases it indicate sever [[left ventricular failure]] and further investigations should be done. | ||
===Common Causes=== | ===Common Causes=== | ||
The most common cause of pulsus alternans is [[Left ventricular failure]], other causes include: | |||
*[[Asthma]] | *[[Asthma]] | ||
*[[Cardiac tamponade]] | *[[Cardiac tamponade]] | ||
*[[Peripartum cardiomyopathy|Meadows syndrome]] | *[[Peripartum cardiomyopathy|Meadows syndrome]] | ||
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|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' | |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' | ||
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | | |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Cardiac tamponade]], [[Peripartum cardiomyopathy|Meadows syndrome]], [[premature ventricular contraction]], [[Aortic insufficiency|severe aortic regurgitation]] | ||
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=== Causes in Alphabetical Order === | === Causes in Alphabetical Order === | ||
*[[Asthma]] | |||
*[[Cardiac tamponade]] | |||
*[[Left ventricular failure]] | |||
*[[Peripartum cardiomyopathy|Meadows syndrome]] | |||
*[[Premature ventricular contraction]] | |||
*[[Aortic insufficiency|Severe aortic regurgitation]] | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Mature chapter]] | [[Category:Mature chapter]] | ||
[[Category:Medical signs]] | |||
[[Category:Signs and symptoms]] | [[Category:Signs and symptoms]] | ||
[[Category:Physical examination]] | [[Category:Physical examination]] | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] | ||
{{Circulatory system pathology}} | {{Circulatory system pathology}} | ||
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Latest revision as of 18:26, 12 June 2015
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S.; Mohamed Moubarak, M.D. [2]
Overview
Pulsus alternans is a physical finding with arterial pulse waveform showing alternating strong and weak beats.[1] It is almost always indicative of left ventricular systolic impairment, and carries a poor prognosis.
Pathophysiology
The mechanism of pulsus alternans was referred to Starling's law of the heart.[2] The ejection fraction will decrease significantly in cases of left ventricular dysfunction, which is the most important cause of pulsus alternans, causing reduction in stroke volume, and this reduction results in an increase in the end-diastolic volume. As explained by Starling's law, during the next cycle of systolic phase, the myocardial muscle will be stretched more than usual and causes an increase in myocardial contraction, this in turn results in a stronger systolic pulse.
Causes
Overview
The presence of pulsus alternans almost indicate severe left ventricular failure, and patients should undergo further investigations for proper management.
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Pulsus alternans in itself is not a life threatening condition, but in most of cases it indicate sever left ventricular failure and further investigations should be done.
Common Causes
The most common cause of pulsus alternans is Left ventricular failure, other causes include:
Causes by Organ System
| Cardiovascular | Cardiac tamponade, Meadows syndrome, premature ventricular contraction, severe aortic regurgitation |
| Chemical / poisoning | No underlying causes |
| Dermatologic | No underlying causes |
| Drug and Toxin Side Effect | No underlying causes |
| Ear Nose Throat | No underlying causes |
| Endocrine | No underlying causes |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | [No underlying causes |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying cause |
| Infectious Disease | No underlying causes |
| Musculoskeletal / Ortho | No underlying causes |
| Neurologic | No underlying cause |
| Nutritional / Metabolic | No underlying cause |
| Obstetric/Gynecologic | No underlying cause |
| Oncologic | No underlying causes |
| Opthalmologic | No underlying causes |
| Overdose / Toxicity | [No underlying causes |
| Psychiatric | No underlying causes |
| Pulmonary | Asthma |
| Renal / Electrolyte | No underlying causes |
| Rheum / Immune / Allergy | No underlying causes |
| Sexual | No underlying causes |
| Trauma | No underlying causes |
| Urologic | No underlying causes |
| Miscellaneous | No underlying causes |
Causes in Alphabetical Order
References
- ↑ Euler D (1999) Cardiac alternans: mechanisms and pathophysiological significance. Cardiovascular Research. Vol. 42. P. 583-590. PMID 10533597
- ↑ GLEASON WL, BRAUNWALD E (1962). "Studies on Starling's law of the heart. VI. Relationships between left ventricular enddiatolic volume and stroke volume in man with observations on the mechanism of pulsus alternans". Circulation. 25: 841–8. PMID 13899176.