Biventricular pulsus alternans

Biventricular pulsus alternans (BVPA)

Pulsus alternans is alternating volume of pulse, with a regular rhythm, mostly seen with severe left ventricular dysfunction. Biventricular and right ventricular pulsus alternans needs cardiac catheterization or Doppler echocardiography to demonstrate the alternating right ventricular or pulmonary artery systolic pressures. BVPA is much rarer than left ventricular pulsus alternans.

One case reported was biventricular pulsus alternans due to anterior wall myocardial infarction [1]. The left ventricular ejection fraction was 31% and BVPA was demonstrated during cardiac catheterization as beat to beat variation in aortic, pulmonary artery, left ventricular and right ventricular systolic pressures.

Another report was an echocardiographic demonstration of BVPA by echocardiography in a case of pulmonary embolism [2]. A combination of dilated cardiomyopathy and pulmonary embolism was responsible for BVPA in another case [3]. The demonstration of alternans was the alternating left ventricular and right ventricular outflow velocities. A diastolic alternans was also described in the inflow velocities, though strictly the term diastolic pulsus alternans is not ideal because there is no pulse in diastole in this case!

References

1. Vidwan P, Stouffer GA. Cardiol Res Pract. 2009;2009:703793.
2. Nguyen T, Cao LB, Tran M, Movahed A. World J Clin Cases. 2013 Aug 16;1(5):162-5.
3. Szymanski P, Lipczynska M, Klisiewicz A, Hoffman P. Heart. 2014 Jan;100(1):83, 90.