Extreme Pulsus Alternans

Abstract

Timing of events, as well as the pattern of occurrences, are important details to pay attention to. Occasionally, a discrepancy can be found between electrical and mechanical activity of the heart, and echocardiography can be a tool to identify such inconsistency. Moreover, there can be a discrepancy between the mechanical activation of the heart, and the efficiency of the heart (i.e., the production of cardiac output), and echocardiography can play a central role in diagnosing such a situation. Combining information from ECG tracing, 2D and tissue Doppler assessment of contractility, and spectral tracing across the LVOT can provide evaluation of the electrical activation of the heart, mechanical activation of the heart, and the ultimate “success” of these activation efforts in producing cardiac output.