Right ventricular pulsus alternans

RV pulsus alternans

RV pulsus alternans can be isolated or associated with left ventricular pulsus alternans. RV and pulmonary artery (PA) pulsus alternans are demonstrated by cardiac catheterization studies. In one case of RV pulsus alternans due to right ventricular infarction reported by Sammy Elmariah, Ravi V Shah, William J Kostis, J Travis Hinson, Michael H Picard and Igor F Palacios, improvement was obtained by coronary sinus pacing [1].

Doppler alternans and murmur alternans corresponding to RV pulsus alternans has been noted by Mehnaz Atiq, Saleem Akhter, Sheikh Abdul Sattar, Shazia Mohsin and Nadeem Aslam in critical pulmonary stenosis with right ventricular dysfunction [2]. Pulmonary embolism and pulmonary hypertension [3] are other situations in which RV and PA pulsus alternans has been observed by Masahiro Ito, Makoto Kodama, Tomomi Nagao and Yoshifusa Aizawa.

A rare occurrence of RV and PA pulsus alternans was in a case of prosthetic mitral valve thrombosis has been reported by Akram Abu-Ful, Reuben Ilia and Yaakov Henkin [4]. In an interesting case of right pulsus alternans in left ventricular diastolic dysfunction, pulsus alternans was demonstrated in right ventricle, pulmonary artery and pulmonary artery wedge positions, but not in the left ventricle or aorta by Ilia R, Abu-Ful A, Weinstein JM and Merkin M [5].

Reference

1. Sammy Elmariah, Ravi V Shah, William J Kostis, J Travis Hinson, Michael H Picard, Igor F Palacios. Tex Heart Inst J. 2013;40(4):497-9.
2. Mehnaz Atiq, Saleem Akhter, Sheikh Abdul Sattar, Shazia Mohsin, Nadeem Aslam. Murmur and Doppler alternans in critical pulmonary stenosis. Pediatr Cardiol. 2011 Oct;32(7):1004-7.
3. Masahiro Ito, Makoto Kodama, Tomomi Nagao, Yoshifusa Aizawa. Isolated right-sided pulsus alternans in pulmonary arterial hypertension. Intern Med. 2011;50(11):1257.
4. Akram Abu-Ful, Reuben Ilia, Yaakov Henkin. Right-sided pulsus alternans in prosthetic mitral valve thrombosis. J Invasive Cardiol. 2004 Apr;16(4):213-4.
5. Ilia R, Abu-Ful A, Weinstein JM, Merkin M. Right-sided pulsus alternans in diastolic left ventricular dysfunction. Catheter Cardiovasc Interv. 1999 Jul;47(3):336-9.