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Pulsus alternans: a visual clue to a grave disorder!
  1. Veerajalandhar Allareddy1,
  2. Morgan L Grundstad2,
  3. Aditya Badheka3
  1. 1Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa, USA
  2. 2Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
  3. 3Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
  1. Correspondence to Dr Aditya Badheka, aditya-badheka{at}uiowa.edu

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A 15-year-old, previously healthy teenager who had fatigue, shortness of breath, vomiting, chest discomfort, lower extremity oedema and inability to lay flat for 3 weeks prior to her initial presentation. She was warm, well perfused with alternating strong and weak central as well as peripheral pulses and laterally displaced cardiac impulse. Her monitoring showed visual evidence of ‘pulsus alternans’—alternating low and high amplitude waveforms on the arterial waveform and plethysmography (figure 1). Her echocardiography showed severely …

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