Diastolic pulsus alternans

Diastolic pulsus alternans

Though there is no pulse felt in diastole, diastolic pulsus alternans (DPA) has been described as the alternation of mitral inflow velocities. In one case it was due dilated cardiomyopathy and pulmonary embolism [1]. Another report was in severe heart failure [2] where they demonstrated both DPA and systolic pulsus alternans. Alternation in ventricular diastolic function can be documented both by Doppler echo and Tissue Doppler imaging [3]. Continuous wave Doppler (CW) interrogation showed alternation of beat to beat aortic flow velocity with peak velocity alternating between 80 centimeters per second and 40 centimeters per second, a surrogate of systolic alternans. Peak early diastolic mitral annular velocity alternated between 8 centimeters per second and 6 centimeters per second, indicating diastolic alternans.

Earlier description of DPA was alternation in the left ventricular diastolic pressures, as in a case of hypertrophic cardiomyopathy [4]. They noted that DPA was not corrected by isoprenaline infusion. They presumed that it is possibly independent of systolic pulsus alternans.

Reference

1. Szymanski P, Lipczynska M, Klisiewicz A, Hoffman P. “Like a sound and its echo”. Biventricular pulsus alternans. Heart. 2014 Jan;100(1):83, 90.
2. Perk G, Tunick PA, Kronzon I. J Am Soc Echocardiogr. 2007 Jul;20(7):905.e5-7.
3. Edwards P, Cohen GI. Both diastolic and systolic function alternate in pulsus alternans: a case report and review. J Am Soc Echocardiogr. 2003 Jun;16(6):695-7.
4. Yamakado T, Oomichi C, Maeda M, Yamada N, Shibata M, Kakimoto H, Nakano T. Heart Vessels. 1994;9(5):969-72.