Right ventricular pulsus alternans

Right ventricular pulsus alternans can be isolated or associated with left ventricular pulsus alternans. Right ventricular and pulmonary artery pulsus alternans are demonstrated by cardiac catheterization studies. In one case of right ventricular pulsus alternans due to right ventricular infarction, improvement was obtained by coronary sinus pacing [1].

Doppler alternans and murmur alternans corresponding to right ventricular pulsus alternans has been noted in critical pulmonary stenosis with right ventricular dysfunction [2]. Pulmonary embolism and pulmonary hypertension [3] are other situations in which right sided pulsus alternans can be observed.

A rare occurrence of right sided pulsus alternans was in a case of prosthetic mitral valve thrombosis [4]. In an interesting case of right pulsus alternans in left ventricular diastolic dysfunction, pulsus alternans was demonstrated in right ventricle, pulmonary artery and pulmonary artery wedge positions, but not in the left ventricle or aorta [5].


  1. Elmariah S, Shah RV, Kostis WJ, Hinson JT, Picard MH, Palacios IF. Coronary sinus pacing for the management of right ventricular and atrial infarction with isolated right ventricular pulsus alternans. Tex Heart Inst J. 2013;40(4):497-9.
  2. Atiq M, Akhter S, Abdul Sattar S, Mohsin S, Aslam N. Murmur and Doppler alternans in critical pulmonary stenosis. Pediatr Cardiol. 2011 Oct;32(7):1004-7.
  3. Ito M, Kodama M, Nagao T, Aizawa Y. Isolated right-sided pulsus alternans in pulmonary arterial hypertension. Intern Med. 2011;50(11):1257.
  4. Abu-Ful A, Ilia R, Henkin Y. Right-sided pulsus alternans in prosthetic mitral valve thrombosis. J Invasive Cardiol. 2004 Apr;16(4):213-4.
  5. Ilia R, Abu-Ful A, Weinstein JM, Merkin M. Right-sided pulsus alternans in diastolic left ventricular dysfunction. Catheter Cardiovasc Interv. 1999 Jul;47(3):336-9.