Diastolic pulsus alternans

Though there is no pulse felt in diastole, diastolic pulsus alternans has been described as the alternation of mitral inflow velocities. In one case it was due dilated cardiomyopathy and pulmonary embolism [1]. Another report was in severe heart failure [2]. Alternation in ventricular diastolic function can be documented both by Doppler echo and Tissue Doppler imaging [3].

Earlier description of diastolic pulsus alternans was alternation in the left ventricular diastolic pressures, as in a case of hypertrophic cardiomyopathy [4].


  1. Szymanski P, Lipczynska M, Klisiewicz A, Hoffman P. “Like a sound and its echo”. Biventricular pulsus alternans. Heart. 2014 Jan;100(1):83, 90.
  2. Perk G, Tunick PA, Kronzon I. Systolic and diastolic pulsus alternans in severe heart failure. J Am Soc Echocardiogr. 2007 Jul;20(7):905.e5-7.
  3. Edwards P, Cohen GI. Both diastolic and systolic function alternate in pulsus alternans: a case report and review. J Am Soc Echocardiogr. 2003 Jun;16(6):695-7.
  4. Yamakado T, Oomichi C, Maeda M, Yamada N, Shibata M, Kakimoto H, Nakano T. Left ventricular diastolic pulsus alternans in hypertrophic cardiomyopathy. Heart Vessels. 1994;9(5):969-72.