Biventricular Pulsus Alternans英文文献资料.docVIP

SAGE-HindawiAccesstoResearch CardiologyResearchandPractice Volume2009,ArticleID703793,3pages doi:10.4061/2009/703793 CaseReport BiventricularPulsusAlternans ParamVidwanandGeorgeA.Stouffer DivisionofCardiology,UniversityofNorthCarolina,ChapelHill,NC27599-7075,USA CorrespondenceshouldbeaddressedtoGeorgeA.Stou?er,rstou?@ Received27April2009;Accepted27June2009 RecommendedbyGeraldMaurer Pulsusalternansisararehemodynamicconditioncharacterizedbybeat-to-beatvariabilityinsystolicpressure.Itisattributedto variationsinstrokevolumewithalternatecardiaccyclesandistypicallyseeninpatientswithadvancedmyopathicconditions.Left ventricularpulsusalternansisrare,andrightventricularpulsusalternansisevenlesscommon.Thereareonlyafewreportsof biventricularpulsusalternans.Wereportthecaseofa62-year-oldfemalewitharecentanteriorwallmyocardialinfarctionwho hadbiventricularpulsusalternansatthetimeofcardiaccatheterization. Copyright?2009P.VidwanandG.A.Stou?er.ThisisanopenaccessarticledistributedundertheCreativeCommonsAttribution License,whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperly cited. 1.CaseReport (25mgBID),quinapril(40mgqD),andfurosemide(20mg qD). A62-year-oldfemalewith diabetesmellitusandhyperten- sion developed what she thought was the “?u” associated with orthopnea, shortness of breath, and chest pressure. She presented to her local physician 3 weeks later when thesymptomspersistedandwereaccompaniedbya15–20 pound weight gain. Her BNP was markedly elevated and a chest X-ray showed cardiomegaly with bilateral pleural e?usion. ECG and echocardiogram were consistent with a recentanteriorwallmyocardialinfarction. Cardiaccatheterizationaftera15pounddiuresisshowed severely reduced left ventricular systolic function with an ejection fraction of 31%. Left heart ?lling pressures were elevated with a left ventricular end diastolic pressure of 26mmHg and pulmonary capillary wedge pressure of 28mmHg. She had severe disease of the mid left ante-