Doppler alternans in pediatric emergency: correlation between clinical, Doppler waveforms and silent ventricular dysfunction by POCUS echo

Authors

  • Munesh Tomar Department of Pediatrics, LLRM Medical College, Meerut Uttar Pradesh, India http://orcid.org/0000-0002-4465-7907
  • Maitri Chaudhuri Department of Pediatrics Cardiology, Manipal Hospital, Bangalore, Karnataka, India
  • Hariraj Singh Tomar Department of Pediatrics Cardiology, Manipal Hospital, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20223068

Keywords:

POCUS, PA, Aorta Doppler, Ventricular dysfunction

Abstract

Pulsus alternans (PA), reported in nineteenth century, is a subtle abnormality, often missed in emergency situations. However, the significance lies in its association with severe ventricular dysfunction. This case reports an 8-year-old child presenting with heart failure in emergency department. Abdominal aortic Doppler displayed pulsus/Doppler alternans. Step by step investigation of Doppler clue unearthed severe left ventricular dysfunction secondary to systemic arterial hypertension.

References

Traube L. Ein Fall xon Pulsus bigeminus nebst Bemerkungen tiber die Lebershwellungen bei Klappenfehlern und iiber acute Leberatrophic. Ber Klin Wschr. 1872;9:185.

Cohn KE, Sandler H, Hancock EW. Mechanisms of pulsus alternans. Circulation. 1967;36(3):372-80.

Nguyen T, Cao LB, Tran M, Movahed A. Biventricular pulsus alternans: An echocardiographic finding in patient with pulmonary embolism. World J Clin Cases. 2013;1(5):162-5.

Edwards P, Cohen GI. Both diastolic and systolic function alternate in pulsus alternans: a case report and review. J Am Soc Echocardiogr. 2003;16:695-7.

Schmidt AG, Kadambi VJ, Ball N, Sato Y, Walsh RA, Kranias EG et al. Cardiac-specific overexpression of calsequestrin results in left ventricular hypertrophy, depressed force-frequency relation and pulsus alternans in vivo. J Mol Cell Cardiol. 2000;32:1735-44.

Vidwan P, Stouffer GA. Biventricular pulsus alternans. Cardiol Res Pract. 2009;2009:703-93.

Cournand A, Ferrer MI, Harvey RM, Richards DW. Cardiocirculatory studies in pulsus alternans of the systemic and pulmonary circulations. Circulation. 1956;14:163-74.

Perk G, Tunick PA, Kronzon I. Systolic and diastolic pulsus alternans in severe heart failure. J Am Soc Echocardiogr. 2007;20(7):905.e5-7.

Costello DL, Gaasch WH, Criscitiello MG. Echocardiographic examination in left ventricular alternans. Chest 1979;75:72-5.

Downloads

Published

2022-11-24

Issue

Section

Case Reports