Alternating pulse: here and there

When assessing the circulatory system, the rhythm and nature of the peripheral pulse are observed. When palpating the radial or femoral pulses, you’ll notice that although the rhythm is regular, the strength of the heartbeat may vary between weaker and stronger pulses. Hence the term

Beat-to-beat pulse variability might be confirmed by utilizing a blood pressure cuff and listening fastidiously because the cuff is deflated. Initially, only stronger Korotkoff sounds are heard, but because the cuff pressure decreases further, quieter sounds appear and eventually disappear (Bickley et al., 2021).

The presence of alternating pulses strongly suggests severe left ventricular dysfunction (Bickley et al., 2021; Corlucci and Borlaug, 2021). Pulsus alternans could also be seen in individuals with dilated cardiomyopathy with left ventricular outflow obstruction, severe aortic regurgitation, or cardiac tamponade, but rarely without associated left ventricular dysfunction (Gersh, 2021).

Remember…

• Asking the patient to sit down upright during a physical examination may highlight this remark.
• Pulsus alternans is usually related to left ventricular failure, and this finding should prompt further diagnostic testing.

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s guide to physical examination and interviewing (thirteenth ed.). Wolters Kluwer Health: Philadelphia.

Corlucci, W. S., & Borlaug, B. A. (2021, March 4). Heart failure: clinical symptoms and diagnosis in adults. https://www.uptodate.com/contents/heart-failure-clinical-manifestations-and-diagnosis-in-adults

Gersh, B. J. (2021, November 2). Arterial pulse examination. https://www.uptodate.com/contents/examination-of-the-arterial-pulse