Medical image of the week: pulsus alternans

• Main Author: Gabe LM
• Format: Article
• Language: English
• Published: Arizona Thoracic Society 2016-11-01
• Series: Southwest Journal of Pulmonary and Critical Care
• Subjects: pulsus; alternans; cardiac; alternating; pulse; heart failure; congestive heart failure; amphetamine; mechanism; prognosis
• Online Access: http://www.swjpcc.com/imaging/2016/11/30/medical-image-of-the-week-pulsus-alternans.html

No abstract available. Article truncated at 150 words. A 52 year old man with a known past medical history of morbid obesity (BMI, 54.6 kg/m2), heart failure with preserved ejection fraction, hypertension, untreated obstructive sleep apnea, and obesity hypoventilation syndrome presented with increasing dyspnea over several months accompanied by orthopnea and weight gain that the patient had treated at home with a borrowed oxygen concentrator. On arrival to the Emergency Department, the patient was in moderate respiratory distress and hypoxic to SpO2 70% on room air. Physical examination was pertinent for pitting edema to the level of the chest. Assessment of jugular venous pressure and heart and lung auscultation were limited by body habitus, but chest radiography suggested pulmonary edema. The patient refused aggressive medical care beyond supplemental oxygen and diuretic therapy. Initial transthoracic echocardiography was limited due to poor acoustic windows but suggested a newly depressed left ventricular ejection fraction (LVEF) of <25%. The cause, though uncertain …