Traube’s pulse – pulsus alternans

Traube’s pulse – pulsus alternans

Pulsus alternans or Traube’s pulse was described by Ludwig Traube in 1872 [1]. Traube’s pulse is nothing but alternating pulses having different volumes and is a feature of left ventricular dysfunction. It is well known that Traube’s pulse can be augmented by a premature ventricular contraction [2].

A rare case of pulsus alternans due to 2:1 left bundle branch block (LBBB) has also been described [3]. The patient had normal coronaries and a left ventricular ejection fraction of 50%. The dyssynchrony associated with LBBB was thought to reduce left ventricular output during the block and consequent lower pulse volume in alternating beats.

Pulsus alternans with diastolic left ventricular dysfunction in the absence of systolic dysfunction was noted in a case of renal artery stenosis and pulmonary edema [4]. The pulsus alternans in this case disappeared after renal revascularization.

Treatment of heart failure causes improvement in pulsus alternans [5]. Similarly, improvement in pulsus alternans by ventilation therapy has been documented [6].

References

1. Conti AA. Nineteenth century “Traube’s pulse” and current “Cardiac alternans”: significant features in the history of cardiology. Clin Ter. 2012;163(2):e71-2.
2. Panutich MS, Knight BP. Augmentation of pulsus alternans by a premature ventricular beat. J Cardiovasc Electrophysiol. 2006 Aug;17(8):918.
3. Barold SS, Herweg B. Pulsus alternans caused by 2:1 left bundle branch block. J Interv Card Electrophysiol. 2005 Apr;12(3):221-2.
4. Kwan T, Feit A, Alam M, Mandawat MK, Clark LT. Pulsus alternans in diastolic left ventricular dysfunction–a case report. Angiology. 1997 Dec;48(12):1079-85.
5. Kobayashi S, Susa T, Tanaka T, Murakami W, Fukuta S, Okuda S, Doi M, Wada Y, Nao T, Yamada J, Okamura T, Yano M, Matsuzaki M. Low-dose β-blocker in combination with milrinone safely improves cardiac function and eliminates pulsus alternans in patients with acute decompensated heart failure. Circ J. 2012;76(7):1646-53. Epub 2012 Apr 5.
6. Haruki N, Takeuchi M, Yoshitani H, Otani K, Kuwaki H, Iwataki M, Abe H, Tamura M, Okazaki M, Otsuji Y. Immediate amelioration of mechanical pulsus alternans by adaptive servo-ventilation therapy. Heart Lung Circ. 2013 Apr;22(4):300-2.