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Figure 1. A 51-year-old woman presented with dyspnea on exertion and cardiomegaly. She had a long-standing history of poorly controlled hypertension. Physical examination revealed an elevated jugular venous pressure, clear lungs, a left ventricular S3, and prominent pulsus alternans on examination of her peripheral pulses. Cardiac catheterization revealed normal coronary arteries and severe, global left ventricular systolic dysfunction, with an ejection fraction of 15 percent. Right-sided hemodynamics were consistent with the presence of severe biventricular congestive heart failure. Although pulsus alternans was present before ventriculography, the tracing of the aortic pressure shown here was obtained after ventriculography, at . . . [Full Text of this Article] |
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