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      Biventricular Pulsus Alternans in a Dog with Pulmonic Stenosis and Sepsis

      case-report
      Author(s): , DVM, MS, Dipl. ACVIM (Cardiology) a , , DVM a , b , , DVM a , c
      Publication date (Electronic):
      Journal: CASE : Cardiovascular Imaging Case Reports
      Publisher: Elsevier
      Keywords: Biventricular alternans, Myocardial function, Canine, Doppler echocardiography, Murmur

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          Graphical abstract

          Highlights

          • •

            Pulsus alternans is characterized by beat-to-beat variability in cardiac contractile strength.

          • •

            Besides severe LV failure, hypovolemia and tachycardia can provoke pulsus alternans.

          • •

            Right ventricular or biventricular alternans is reported only sporadically in people.

          • •

            The first biventricular pulsus alternans in the veterinary clinical literature is presented.

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          Most cited references15

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          Echocardiographic assessment of right ventricular systolic function in conscious healthy dogs: repeatability and reference intervals.

          Lance C Visser, Brian A Scansen, Karsten E Schober … (2015)
          To determine the feasibility, repeatability, intra- and interobserver variability, and reference intervals for 5 echocardiographic indices of right ventricular (RV) systolic function: tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), pulsed wave tissue Doppler imaging-derived systolic myocardial velocity of the lateral tricuspid annulus (S'), and speckle-tracking echocardiography-derived global longitudinal RV free wall strain and strain rate. To explore statistical relationships between RV systolic function and age, gender, heart rate, and bodyweight.
          Article 0 comments Cited 28 times – based on 0 reviews     Review now
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            Cardiac alternans: diverse mechanisms and clinical manifestations.

            Borys Surawicz, Charles Fisch (1992)
            The purpose of this review is to assemble the widely dispersed information about cardiac alternans and to categorize the types and mechanisms of alternans, their clinical manifestations and possible therapeutic implications. The phenomena of mechanical and electrical alternans have been of continuing interest to both physiologists and clinicians. Recent studies have enhanced this interest because of the reported association of alternans with experimental myocardial ischemia and cardiac arrhythmias. The review formulates concepts based on extensive review of published studies and personal observations. Cardiac alternans has been subdivided into the following four categories: 1) mechanical, 2) electrical, 3) in association with myocardial ischemia, and 4) in association with cardiac motion. Mechanical alternans can be explained by hemodynamic or inotropic alterations, or both. Mechanical alternans in the ventricular muscle is accompanied by alternans of action potential shape. In the Purkinje fibers, action potential duration alternates without change in shape and is determined by the duration of the preceding diastolic interval. However, in ventricular muscle fiber, alternans can occur in the presence of constant diastolic intervals. T wave alternans reflects changes in action potential duration and is frequently associated with a long QT interval. Electrocardiographic manifestations of conduction alternans occur at many different sites within the conducting system and myocardium. During myocardial ischemia, additional mechanisms of repolarization alternans have been proposed. Alternans occurring in the presence of a large pericardial effusion is attributed to swinging motion of the heart maintaining two-beat periodicity. Since its origin as "pulsus alternans" described by Traube in 1872, the definition of alternans has evolved into a term encompassing multiple physiologic and pathologic phenomena that, although united by the term cardiac alternans, diverge widely with respect to etiology, mechanism and clinical significance.
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              Calcium alternans in cardiac myocytes: order from disorder.

              Zhilin Qu, Michael Nivala, James Weiss (2013)
              Calcium alternans is associated with T-wave alternans and pulsus alternans, harbingers of increased mortality in the setting of heart disease. Recent experimental, computational, and theoretical studies have led to new insights into the mechanisms of Ca alternans, specifically how disordered behaviors dominated by stochastic processes at the subcellular level become organized into ordered periodic behaviors. In this article, we summarize the recent progress in this area, outlining a holistic theoretical framework in which the complex effects of Ca cycling proteins on Ca alternans are linked to three key properties of the cardiac Ca cycling network: randomness, refractoriness, and recruitment. We also illustrate how this '3R theory' can reconcile many seemingly contradictory experimental observations.
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                Author and article information

                Journal
                Journal ID (nlm-ta): CASE (Phila)
                Journal ID (iso-abbrev): CASE (Phila)
                Title: CASE : Cardiovascular Imaging Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2468-6441
                Publication date PMC-release: 22 January 2021
                Publication date Collection: April 2021
                Publication date (Electronic): 22 January 2021
                Volume: 5
                Issue: 2
                Pages: 105-109
                Affiliations
                [a ]Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa
                [b ]Purdue University Veterinary Teaching Hospital, West Lafayette, Indiana
                [c ]Mission Veterinary and Specialty, Mission, Kansas
                Article
                Publisher Item ID: S2468-6441(20)30204-8
                DOI: 10.1016/j.case.2020.12.004
                PMC ID: 8071959
                SO-VID: 824c4472-c498-4987-bdef-0ab1646501aa
                Copyright © 2020 by the American Society of Echocardiography. Published by Elsevier Inc.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Categories
                Subject: Biventricular Pulsus Alternans

                Keywords: biventricular alternans,myocardial function,canine,doppler echocardiography,murmur
                Data availability:
                Keywords: biventricular alternans, myocardial function, canine, doppler echocardiography, murmur

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