# The patient's cardiovascular exam reveals ______ pulse, where alternate beats are weaker or absent, indicating pulsus alternans.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=168390  
> language: ko  
> subject: Diseases of the circulatory system

## 문제

The patient's cardiovascular exam reveals ______ pulse, where alternate beats are weaker or absent, indicating pulsus alternans.

## 보기

1. alternating **✔ 정답**
2. irregular
3. variable
4. paradoxical
5. bisferiens

**정답: 1**

## 해설

An alternating pulse, or pulsus alternans, is characterized by regular rhythm but alternating strong and weak beats. This finding is often associated with severe left ventricular systolic dysfunction and is a concerning sign in heart failure.

## 임상 시나리오

Key Points about Pulsus Alternans:

1. Definition: Regular alternation between strong and weak pulse beats

2. Clinical Significance:
- Indicator of severe left ventricular dysfunction
- Common in advanced heart failure
- Associated with poor cardiac contractility

3. Characteristics:
- Regular rhythm maintained
- Alternating amplitude of pulse pressure
- Detectable in peripheral pulses

4. Pathophysiology:
- Results from beat-to-beat variation in stroke volume
- Related to impaired myocardial contractility
- Occurs when ventricle fails to maintain consistent output

5. Associated Conditions:
- Congestive heart failure
- Aortic stenosis
- Dilated cardiomyopathy
- Severe systolic dysfunction

6. Diagnostic Value:
- Poor prognostic sign
- Indicates need for detailed cardiac evaluation
- May require urgent medical intervention

7. Differentiation:
- Distinct from pulsus paradoxus
- Different from pulsus bigeminus
- Not same as irregular rhythm

## 핵심 개념

- **alternating** — A pulse pattern where strong and weak beats occur in a regular alternating sequence, typically indicating severe heart failure
- **irregular** — A pulse that lacks a consistent rhythm or pattern, with beats occurring at unpredictable intervals
- **variable** — A pulse that changes in strength or character but without a specific pattern
- **paradoxical** — A pulse that decreases during inspiration and increases during expiration, contrary to normal physiological patterns
- **bisferiens** — A pulse with two peaks during systole, commonly associated with aortic valve disease or hypertrophic cardiomyopathy

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