Pulsus Alternans Involving the Right Heart

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Abstract
Pulsus alternans involving the right side of the heart was studied in 5 patients. Four of 5 patients had mitral stenosis with severe pulmonary hypertension and the other had postpartum myocardial disease with clinical signs indicating both left and right heart failure. Pulsus alternans in the pulmonary circulation was elicited in close connection with severe right ventricular strain or failure. Premature beat of ventricular origin was one of the most important trigger mechanism initiating pulsus alternans. Contrary to the previous opinion in the literature pulsus alternans following premature beats could persist for a rather long time, at least in the presence of pulmonary hypertension. Pulsus alternans was induced in a patient by exercise as the pulmonary hypertension was exaggerated. Alternation of the right ventricular diastolic and right atrial pressures was found in 2 patients in addition to that of the right ventricular systolic pressure. However, it could not be considered that the atrial or right ventricular diastolic alternation played an important role in the genesis of pulsus alternans in the pulmonary circulation.