Pulsus Alternans


Categories: Uncategorized
Sources: Disturbances Of The Heart

By this term is meant that condition of pulse in which, though the

rhythm is normal, strong and weak pulsations alternate. White

[Footnote: White: Am. Jour. Med. Sc., July, 1915, p. 82.] has shown

that this condition is not infrequent, as demonstrated by

polygraphic tracings. He found such a condition present In seventy-

one out of 300 patients examined, and he believes that if every

decompensating heart with arrhythmia was graphically examined, this

condition would be frequently found. The alternation may be

constant, or it may occur in phases. It is due to a diminished

contractile power of the heart when the heart muscle has become

weakened and a more or less rapid heart action is present.



Gordinier [Footnote: Gordinier: Am. Jour. Med. Sc., February, 1915,

p. 174.] finds that most of these patients with alternating pulse

are suffering from general arteriosclerosis, hypertension, chronic

myocarditis, and chronic nephritis, in other words, with

cardiovascularrenal disease. He finds that it frequently occurs with

Cheyne-Stokes respiration, and continues until death. He also finds

that the condition is not uncommon in dilated hearts, especially in

mitral disease, and with other symptoms of decompensation.



White found that about half of his cases of pulsus alternans showed

an increased blood pressure of 160 mm. or more; 62 percent. were in

patients over 50 years of age, and 69 percent. were in men.

Necropsics on patients who died of this condition showed coronary

sclerosis and arteriosclerotic kidneys.



The onset of dyspnea, with a rapid pulse, should lead one to suspect

pulsus alternans when such a condition occurs in a person over 50

with cardiovascular-renal disease, arid with signs of

decompensation, and also when such a condition occurs with a patient

who has a history of angina pectoris.



While the forcefulness of the varying beats of an alternating pulse

may be measured by blood pressure instruments by the auscultatory

method, White and Lunt [Footnote: White, P. D. and Lunt, L. K.: The

Detection of Pulsus Alternans, THE JOURNAL A. M. A., April 29, 1916,

p. 1383.] find that in only about 30 percent. of the cases, the

graver types of the condition, is this a practical procedure.



Pulsus alternans, except when it is very temporary, Gordinier finds

to be of grave import, as it shows myocardial degeneration, and most

patients will die from cardiac insufficiency in less than three

years from the onset of the disturbance.



The treatment is rest in bed and digitalis, but White found that in

only four patients out of fifty-three so treated was the alternating

pulse either "diminished or banished." In a word, the only treatment

is that of decompensation and a dilated heart, and when such a

condition occurs and is not immediately improved, the prognosis is

bad, under any treatment.





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