What disease is alternating pulse seen in?

Pulse alternans refers to a pathological condition in which the body's normal pulse alternates between strong and weak. Pulse alternans is common in human heart disease and can easily lead to heart failure, high blood pressure, coronary heart disease, etc. It can also easily cause arrhythmia resulting in a rapid heartbeat, or abnormalities in the arteries, etc., which require timely examination and treatment.

What diseases are seen in alternating pulse?

Pulse alternating

Pulse alternans refers to a pathological phenomenon in which the pulse rhythm is normal but the pulse strength alternates between weak and strong, which is more obvious in the sitting position. It is related to the alternation of strong and weak ventricular contractility, and often indicates left ventricular dysfunction. The occurrence of pulse alternans indicates myocardial damage and failure and is strong evidence of latent heart failure. Early detection, early diagnosis and early treatment of organic diseases.

Causes and common diseases

1. Heart disease

Various organic heart diseases that cause left heart failure, such as severe hypertension, severe coronary heart disease, dilated cardiomyopathy, etc.

2. Irregular heartbeat

Digitalis intoxication, paroxysmal tachycardia, and atrial fibrillation. Premature beats may also cause a brief alternating pulse.

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1. Physical signs

Cardiac examination revealed an enlarged heart (mainly left ventricle), increased heart rate, a diastolic gallop (S3 gallop), hypertrophy of P2, and moist rales at both lung bases, suggesting left heart failure; the patient had jugular venous pulsation, and auscultation revealed tachycardia or arrhythmia, suggesting arrhythmia.

2. Laboratory examination

(1) X-ray findings of enlarged heart shape, mainly on the left side, and pulmonary congestion indicate left heart failure.

(2) Electrocardiogram: A positive P wave terminal vector (PtfV1) in lead V1 of the electrocardiogram is a common and important indicator for diagnosing left ventricular dysfunction. In addition, electrocardiogram has specific diagnostic value for digitalis poisoning, paroxysmal tachycardia and atrial flutter.

(3) Echocardiography showed left heart enlargement, mainly left ventricular enlargement, decreased stroke volume (SV) and cardiac output (CO), and a decrease in ejection fraction (EF) < 0.50, indicating left heart dysfunction.

(4) Radionuclide and magnetic resonance imaging can measure left ventricular end-systolic and end-diastolic volumes and ejection fraction.

(5) Traumatic hemodynamic examination: The floating catheter can measure the pulmonary capillary wedge pressure, cardiac output (CO), and cardiac index (CI), which are important indicators for diagnosing left ventricular dysfunction.

Differential Diagnosis

1. Left heart failure

① It is seen in severe hypertension, severe coronary heart disease, dilated cardiomyopathy, myocarditis, etc., often with respiratory tract infection, rapid arrhythmia, excessive and other inducements; ② The main symptoms include fatigue, weakness, exertional dyspnea, orthopnea and paroxysmal dyspnea at night, cough and hemoptysis, etc.; ③ The main signs include moist rales at both lung bases or moist rales in the whole lung, hyperactivity of P2, fast heart rate, apical diastolic gallop rhythm and alternating pulse; ④ X-ray shows left heart enlargement, deepening of hilar shadow extending in butterfly shape, decreased lung field transmittance such as cloud-like, etc.; ⑤ Traumatic hemodynamic examination shows increased left ventricular end-diastolic pressure or pulmonary capillary wedge pressure, and prolonged arm-to-tongue circulation time.

2. Hypertensive heart disease

Hypertension complicated with heart failure is more common in patients over 40 years old, with a slightly higher incidence in men, and they often have a history of hypertension for more than 5 to 10 years. Blood pressure often exceeds 21.3/13.3kpa (160/100mmHg). Physical examination, X-ray and electrocardiogram often show obvious changes such as left ventricular hypertrophy and strain. In addition to showing an increase in the left ventricular internal diameter, widening of the aorta, and a stiffer aortic wall, echocardiography also shows an increase in the thickness of the ventricular septum and left ventricular wall.

3. Acute myocardial infarction

When acute myocardial infarction is complicated by pump failure, it may manifest as cardiogenic shock and acute left heart failure, and in severe cases, acute pulmonary edema may occur. Heart failure usually occurs within the first few days of onset, or in the stage of improvement of pain shock. It is caused by a significant weakening or incoordination of cardiac contractility after infarction. The incidence rate is 32% to 48%. Symptoms such as dyspnea, cough, fever, and irritability may occur. In severe cases, pulmonary edema may occur, followed by right heart failure manifestations such as distended jugular veins, hepatomegaly, and edema.

4. Ischemic cardiomyopathy (also known as heart failure and arrhythmia-type coronary heart disease)

It refers to a clinical syndrome similar to primary dilated cardiomyopathy caused by diffuse myocardial fibrosis due to long-term myocardial ischemia caused by coronary atherosclerosis. The clinical features are cardiomegaly and congestive heart failure, which worsen slowly and progressively. Most cases develop left heart failure first, followed by total heart failure. Arrhythmias include atrial or ventricular premature beats and atrial fibrillation.