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