Page 48 - Clinical Pearls in Cardiology

36 Clinical Pearls in Cardiology

11. What is meant by pulsus alternans?
When the pulse amplitude changes beat by beat,
alternating between higher and lower amplitude as a
result of alternating stroke volume, the resulting pulse
is termed as pulsus alternans (Fig. 4).

Fig. 4: Alternating strong and weak pulse with equal
interval in between
Pulses alternans indicate severe left ventricular
dysfunction with reduced ejection fraction. It is often
associated with a S3 gallop. It may also be seen rarely in
systemic hypertension.
12. Which are the three pulses where the character of the
pulse is evaluated in a peripheral artery?
The character of arterial pulse is best assessed by
palpating the carotid artery, except in the following three
types of pulses, where a peripheral artery like radial
artery is used.
• Pulsus paradoxus
• Collapsing pulse
• Pulsus alternans.
13. How will you clinically assess the severity of pulsus
paradoxus?
Normally there is a slight fall in the amplitude of arterial
pulse and blood pressure during inspiration. The term