Echocardiography in mechanical alternans. With a note on the findings in discordant alternans within the left ventricle.

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Abstract
The echocardiographic manifestations of mechanical alternation of left ventricular (LV) contraction during regular sinus rhythm is described. Chronic LV dilatation and failure existed in all 4 cases. Alternation was observed with respect to the following echocardiographic variables: amplitude and rate of increase of amplitude of systolic excursions of the LV posterior wall and ventricular septum (VS); reciprocal changes in the duration of LV ejection and pre-ejection periods (on the aortic valve echo) such that the total duration of LV electromechanical systole remained constant; reciprocal changes in the duration of RV ejection and pre-ejection periods (on the pulmonic valve echo) such that the total duration of RV electromechanical systole remained constant; systolic anterior excursion of the aortic root as a whole; steepness of the mitral EF slope; septal and LV posterior wall diastolic position; and end-systolic LV diameter. In 2 patients, discordant alternans of the motion of the LV posterior wall and the VS was observed.