This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by HARRIS, L. C. Articles by WALLACE, J. M. Search for Related Content PubMed PubMed Citation Articles by HARRIS, L. C. Articles by WALLACE, J. M.

(Circulation. 1966;34:948.)
© 1966 American Heart Association, Inc.

---

Severe Pulsus Alternans Associated with Primary Myocardial Disease in Children

Observations on Clinical Features, Hemodynamic Findings, Mechanism, and Prognosis

LEONARD C. HARRIS M.D., M.R.C.P.¹; QUANG X. NGHIEM M.D.¹; MELVYN H. SCHREIBER M.D.¹; JOHN M. WALLACE M.D.¹

¹ From the Departments of Pediatrics, Radiology, and Internal Medicine, University of Texas Medical Branch, Galveston, Texas.

Five children, including two siblings, with clinically similar primary myocardial disease, were studied. One of the siblings expired 3 years after the onset of symptoms, and autopsy showed features of "cardiovascular collagenosis (endocardiomyopathy)." Moderate-to-severe pulsus alternans was present in all cases and persisted even after control of cardiac failure and return to moderate physical activity. No electrical alternans or bigeminy was observed.

Cardiac catheterizations were performed on all patients. Left ventricular volume was radiographically determined in the siblings. Left ventricular end-diastolic volume was calculated as greater, and end-systolic volume smaller, for large beats as compared with small beats. Though alternating, end-diastolic volume was abnormally large, preceding both small and large beats. End-diastolic pressure alternated in the same way. Beat to beat (R-R) interval, alternating by as much as 0.09 second, was equalized by pacing in the right atrium and right ventricle, with persistence of pulsus alternans to a lesser degree. Isovolumetric contraction time was prolonged preceding small beats in spite of the large preceding end-diastolic volumes.

The data appear to be consistent with Starling's law but suggest that impaired contractility, possibly due to alternate deletion of contractile elements, is an additional etiological factor.

This article has been cited by other articles:

				M. Weber Pulsus Alternans: A Case Study Crit. Care Nurse, June 1, 2003; 23(3): 51 - 54. [Full Text] [PDF]

				L. Gould, C.V. Ramana Reddy, and R. F. Gomprecht Brachial Artery Alternation With Atrial Fibrillation Angiology, June 1, 1973; 24(6): 365 - 368. [PDF]