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successive change from one thing or state to another and back again; "a trill is a rapid alternation between the two notes"

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互い違い,交互,交替

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/06/25 08:46:14」(JST)

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Not to be confused with pulsus paradoxus.

Pulsus alternans is a physical finding with arterial pulse waveform showing alternating strong and weak beats.^[1] It is almost always indicative of left ventricular systolic impairment, and carries a poor prognosis.

Pathophysiology[edit]

In left ventricular dysfunction, the ejection fraction will decrease significantly, causing reduction in stroke volume, hence causing an increase in end-diastolic volume. There may initially be a tachycardia as a compensatory mechanism to try to keep the cardiac output constant. As a result, during the next cycle of systolic phase, the myocardial muscle will be stretched more than usual and as a result there will be an increase in myocardial contraction, related to the Frank–Starling physiology of the heart. This results, in turn, in a stronger systolic pulse .

In literature[edit]

D.H. Lawrence, in his famous novel, "Sons and Lovers" elegantly describes pulsus alternans:^{[citation needed]}

"Then he felt her pulse. There was a strong stroke and a weak one, like a sound and its echo. That was supposed to betoken the end."

References[edit]

^ Euler D (1999) Cardiac alternans: mechanisms and pathophysiological significance. Cardiovascular Research. Vol. 42. P. 583-590. PMID 10533597

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1. 動脈拍動の検討 examination of the arterial pulse
2. 心不全が疑われる患者の評価 evaluation of the patient with suspected heart failure
3. 幼児および小児における孤立性心室中隔欠損の病態生理および臨床的特徴 pathophysiology and clinical features of isolated ventricular septal defects in infants and children
4. 心不全または心筋症患者の評価 evaluation of the patient with heart failure or cardiomyopathy

English Journal

An unusual case of undifferentiated connective tissue disease presenting as cardiac tamponade.

Hari P, Kondur A, Manickam P, Afonso L.SourceWayne State University, Detroit, USA.
Rheumatology international.Rheumatol Int.2012 Jan;32(1):231-4. Epub 2009 Dec 16.
Cardiac tamponade as an initial manifestation of undifferentiated connective tissue diseases (UCTD) is extremely rare, with only one case reported in literature thus far. We describe here, a case of a middle-aged man who presented with symptoms of fatigue, exertional dyspnea and orthopnea. His physi
PMID 20013265

Murmur and Doppler alternans in critical pulmonary stenosis.

Atiq M, Akhter S, Abdul Sattar S, Mohsin S, Aslam N.SourceDepartment of Pediatrics and Child Health, Aga Khan University Hospital, PO Box 3500, Stadium Road, Karachi 74800, Pakistan. mehnaz.atiq@aku.edu
Pediatric cardiology.Pediatr Cardiol.2011 Oct;32(7):1004-7. Epub 2011 Jul 7.
Pulsus alternans is a well-recognized clinical entity in which alternating strong and weak pulses are detected. It usually is secondary to underlying myocardial failure. Murmur alternans (alternation in murmur intensity) has been described in aortic stenosis and a few right-sided lesions such as pul
PMID 21748495

Japanese Journal

Low-Dose β-Blocker in Combination With Milrinone Safely Improves Cardiac Function and Eliminates Pulsus Alternans in Patients With Acute Decompensated Heart Failure

KOBAYASHI Shigeki,SUSA Takehisa,TANAKA Takeo,MURAKAMI Wakako,FUKUTA Seiko,OKUDA Shinichi,DOI Masahiro,WADA Yasuaki,NAO Tomoko,YAMADA Jutaro,OKAMURA Takayuki,YANO Masafumi,MATSUZAKI Masunori
Circulation journal : official journal of the Japanese Circulation Society 76(7), 1646-1653, 2012-06-25
<b><i>Background:</i></b> The purpose of this study was to determine whether a low-dose β-blocker, in combination with milrinone, improves cardiac function in acute decompensat …
NAID 10030503344

Atrioventricular Dissociation Mimicking Pulsus Paradoxus and Palsus Alternans

Kayamori Hiromi,Kashimura Takeshi,Oda Masato,Kodama Makoto
Internal Medicine 51(24), 3439-3440, 2012
NAID 130003308184

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リンク元	「交互脈」「alternation」

「交互脈」

Pulsus alternans
	Classification and external resources
	; Pulse pressure waveform displaying the variation in pressure between beats in pulsus alternans.
DiseasesDB	11040