Heart Rate Alternans
Authors: Philip F. Binkley
Journal: Annals of Internal Medicine (1995)

Brief Communications15 January 1995Heart Rate AlternansPhilip F. Binkley, MD, Gregory M. Eaton, MD, Enrico Nunziata, MSBME, Umesh Khot, BS, and Robert J. Cody, MDPhilip F. Binkley, MDFrom The Ohio State University Medical Center, Columbus, Ohio., Gregory M. Eaton, MDFrom The Ohio State University Medical Center, Columbus, Ohio., Enrico Nunziata, MSBMEFrom The Ohio State University Medical Center, Columbus, Ohio., Umesh Khot, BSFrom The Ohio State University Medical Center, Columbus, Ohio., and Robert J. Cody, MDFrom The Ohio State University Medical Center, Columbus, Ohio.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-122-2-199501150-00007 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Pulsus alternans has long been recognized as a manifestation of severe congestive heart failure [1, 2]. In contrast to the beat-to-beat oscillation in blood pressure that occurs with pulsus alternans, rapid beat-to-beat variations in heart rate are characteristically absent in the setting of ventricular failure [3, 4]. This results in part from the marked attenuation of parasympathetic tone in congestive heart failure, which governs such rapid fluctuations in heart period [3-5]. Further, because of the reduction in baroreflex sensitivity in patients with congestive heart failure, it has been thought unlikely that heart rate would vary in an instantaneous fashion in ...References1. Surawicz B, Fisch C. Cardiac alternans: diverse mechanisms and clinical manifestations. J Am Coll Cardiol. 1992; 20:483-99. Google Scholar2. Lewis T. Notes upon alternation of the heart. Q J Med. 1910; 4:141-4. Google Scholar3. Saul JP, Arai Y, Berger RD, Lilly LS, Colucci WS, Cohen RJ. Assessment of autonomic regulation in chronic congestive heart failure by heart rate spectral analysis. Am J Cardiol. 1988; 61:1292-9. Google Scholar4. Binkley PF, Nunziata E, Haas GJ, Nelson SD, Cody RJ. Parasympathetic withdrawal is an integral component of autonomic imbalance in congestive heart failure: demonstration in human subjects and verification in a paced canine model of ventricular failure. J Am Coll Cardiol. 1991; 18:464-72. Google Scholar5. Eckberg DL, Drobinsky M, Braunwald E. Defective cardiac parasympathetic control in patients with heart disease. N Engl J Med. 1971; 285:877-83. Google Scholar6. Franklin GF, Powell JD, Emami-Naeini A. Feedback Control of Dynamic Systems. New York: Addison-Wesley; 1991:111-3. Google Scholar Author, Article, and Disclosure InformationAffiliations: From The Ohio State University Medical Center, Columbus, Ohio.Corresponding Author: Philip F. Binkley, MD, Division of Cardiology, The Ohio State University Medical Center, 6th Floor Means Hall, 1654 Upham Drive, Columbus, OH 43210-1228.Acknowledgments: The authors thank Trichia Greer for her assistance in the preparation of this manuscript. 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