Critical Care Trauma Centre

ANSWER ARTERIAL LINE 1

What is the significant finding in the following arterial line waveform?



 

Answer:

Pulsus Alternans.

Criteria:

  • Every other arterial pressure wave has a decreased systolic blood pressure.
  • The R - R interval on the ECG and systolic - systolic interval on the arterial line are regular, ruling out arrhythmia as the cause for the fluctuating systolic pressure.
  • Considered a significant difference if there is a 20 mmHg difference between alternating systolic pressures.

Causes:
Generally caused by severe left ventricular failure or pericardial effusion.

Pulsus alternans in a pulmonary artery tracing can indicate severe right ventricular failure.
 

References:

Daily, E., & Schroeder, J. (1994).  Techniques in Bedside Monitoring.  Mosby: Toronto. p. 23, 202, 155-54, 157.
 

Brenda Morgan: January 14, 2000, reviewed January 1, 2019
 

 

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