Pulsus alternans: Difference between revisions

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===Common Causes===
===Common Causes===
=== Causes by Organ System ===
{|style="width:70%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Atrial Septal Defects]], [[cor triatriatum]], [[left heart failure]], [[fallot tetralogy]], [[persistent fetal circulation]], [[mitral valve stenosis]], [[mitral valve insufficiency]], [[ventricular Septal Defect]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug and Toxin Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| [[Pickwickian syndrome]].
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Thyroid diseases]].
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| [[ High altitude sickness|High Altitude(chronically)]].
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Portal Hypertension]].
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Alveolar capillary dysplasia|Alveolar capillary dysplasia with misalignment of pulmonary veins]], [[cholesterol ester storage disease]], [[cystic fibrosis]], [[Gaucher disease]], Indian familial childhood cirrhosis<ref name="pmid23852284">{{cite journal| author=Nayak NC, Chitale AR| title=Indian childhood cirrhosis (ICC) & ICC-like diseases: the changing scenario of facts versus notions. | journal=Indian J Med Res | year= 2013 | volume= 137 | issue= 6 | pages= 1029-42 | pmid=23852284 | doi= | pmc=PMC3734708 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23852284 }} </ref>
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Myeloproliferative disorders]], [[paroxysmal nocturnal haemoglobinuria]], [[polycythemia Vera]], [[splenectomy]](due to [[thrombophilia]]), [[sickle cell disease]].
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying cause
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[ Kaposi's sarcoma-associated herpesvirus|HHV-8]], [[schistosoma japonicum]] and [[schistosoma mansoni]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Scoliosis|Idiopathic spinal scoliosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying cause
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying cause
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying cause
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[Diethylpropion]], monocrotaline,<ref name="pmid9776954">{{cite journal| author=Schultze AE, Roth RA| title=Chronic pulmonary hypertension--the monocrotaline model and involvement of the hemostatic system. | journal=J Toxicol Environ Health B Crit Rev | year= 1998 | volume= 1 | issue= 4 | pages= 271-346 | pmid=9776954 | doi=10.1080/10937409809524557 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9776954 }} </ref> [[phentermine]], [[radiation exposure]] ([[fibrosing mediastinitis]] and [[pulmonary fibrosis]]).
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Idiopathic pulmonary haemosiderosis]], [[sarcoidosis]], [[primary pulmonary hypertension]], [[pulmonary fibrosis]], [[Alveolar capillary dysplasia|alveolar capillary dysplasia with misalignment of pulmonary veins]], [[Cystic fibrosis]], [[Pulmonary embolism]], [[tropical pulmonary eosinophilia]], [[Pulmonary capillary hemangiomatosis]], [[bronchiectasis]],[[bronchopulmonary dysplasia]], [[chronic obstructive pulmonary disease]], [[pulmonary alveolar microlithiasis]],<ref name="pmid23741096">{{cite journal| author=Kashyap S, Mohapatra PR| title=Pulmonary alveolar microlithiasis. | journal=Lung India | year= 2013 | volume= 30 | issue= 2 | pages= 143-7 | pmid=23741096 | doi=10.4103/0970-2113.110424 | pmc=PMC3669555 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23741096 }} </ref> [[pulmonary fibrosis]], [[Langerhans cell histiocytosis]],[[interstitial Lung Disease]].
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[renal failure|Chronic renal failure]] on [[dialysis]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Gaucher disease]], [[glycogen storage diseases]], [[Scoliosis|idiopathic spinal scoliosis]],
|-
|}
=== Causes in Alphabetical Order ===




Revision as of 06:32, 20 November 2013


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S.

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

In left ventricular dysfunction, the ejection fraction will decrease significantly, causing reduction in stroke volume, hence causing a increase in end-diastolic volume. There may initially be a tachycardia as a compensatory mechanism to try to keep the cardiac output constant. As a result, during the next cycle of systolic phase, the myocardial muscle will be stretched more than usual and as a result cause an increase in myocardial contraction, related to the Frank–Starling physiology of the heart. This in turn results in a stronger systolic pulse.

Causes

Life Threatening Causes

Common Causes

Causes by Organ System

Cardiovascular Atrial Septal Defects, cor triatriatum, left heart failure, fallot tetralogy, persistent fetal circulation, mitral valve stenosis, mitral valve insufficiency, ventricular Septal Defect
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug and Toxin Side Effect No underlying causes
Ear Nose Throat Pickwickian syndrome.
Endocrine Thyroid diseases.
Environmental High Altitude(chronically).
Gastroenterologic Portal Hypertension.
Genetic Alveolar capillary dysplasia with misalignment of pulmonary veins, cholesterol ester storage disease, cystic fibrosis, Gaucher disease, Indian familial childhood cirrhosis[2]
Hematologic Myeloproliferative disorders, paroxysmal nocturnal haemoglobinuria, polycythemia Vera, splenectomy(due to thrombophilia), sickle cell disease.
Iatrogenic No underlying cause
Infectious Disease HHV-8, schistosoma japonicum and schistosoma mansoni
Musculoskeletal / Ortho Idiopathic spinal scoliosis
Neurologic No underlying cause
Nutritional / Metabolic No underlying cause
Obstetric/Gynecologic No underlying cause
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity Diethylpropion, monocrotaline,[3] phentermine, radiation exposure (fibrosing mediastinitis and pulmonary fibrosis).
Psychiatric No underlying causes
Pulmonary Idiopathic pulmonary haemosiderosis, sarcoidosis, primary pulmonary hypertension, pulmonary fibrosis, alveolar capillary dysplasia with misalignment of pulmonary veins, Cystic fibrosis, Pulmonary embolism, tropical pulmonary eosinophilia, Pulmonary capillary hemangiomatosis, bronchiectasis,bronchopulmonary dysplasia, chronic obstructive pulmonary disease, pulmonary alveolar microlithiasis,[4] pulmonary fibrosis, Langerhans cell histiocytosis,interstitial Lung Disease.
Renal / Electrolyte Chronic renal failure on dialysis
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous Gaucher disease, glycogen storage diseases, idiopathic spinal scoliosis,

Causes in Alphabetical Order

Related Chapters

Congestive cardiac failure

References

  1. ↑ Euler D (1999) Cardiac alternans: mechanisms and pathophysiological significance. Cardiovascular Research. Vol. 42. P. 583-590. PMID 10533597
  2. ↑ Nayak NC, Chitale AR (2013). "Indian childhood cirrhosis (ICC) & ICC-like diseases: the changing scenario of facts versus notions". Indian J Med Res. 137 (6): 1029–42. PMC 3734708. PMID 23852284.
  3. ↑ Schultze AE, Roth RA (1998). "Chronic pulmonary hypertension--the monocrotaline model and involvement of the hemostatic system". J Toxicol Environ Health B Crit Rev. 1 (4): 271–346. doi:10.1080/10937409809524557. PMID 9776954.
  4. ↑ Kashyap S, Mohapatra PR (2013). "Pulmonary alveolar microlithiasis". Lung India. 30 (2): 143–7. doi:10.4103/0970-2113.110424. PMC 3669555. PMID 23741096.

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