© 1999 by European Society of Cardiology
Copyright © 1999, European Society of Cardiology
Cardiac alternans: mechanisms and pathophysiological significance
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Received 10 August 1998; accepted 5 January 1999
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1. Introduction |
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Mechanical alternans (pulsus alternans) is a condition in which there is a beat-to-beat oscillation in the strength of cardiac muscle contraction at a constant heart rate. Since the first description of pulsus alternans by Traube in 1872 [1], there has been continuing interest in understanding the mechanisms and clinical manifestations of this phenomenon [2,3]. Initially observed in the hearts of laboratory animals, the phenomenon has been reported frequently in patients particularly those with severe heart failure and aortic valve disease. Although much is known about the cellular mechanisms of alternans in isolated cardiac muscle preparations, little is known about the mechanisms by which changes in preload or afterload evoke alternans in the intact heart. The purpose of this review article is to discuss the mechanisms of alternans at both the cellular level and in the intact heart. The relationship between mechanical and electrical alternans is reviewed. The role
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2. Induction of alternans |
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3. Mechanism of alternans |
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4. Alternation of intracellular Ca2+ |
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5. Relaxation alternans |
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6. Importance of preload and afterload |
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7. Role of the sympathetic nervous system |
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8. Alternation of cardiac action potentials |
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9. Diagnostic and prognostic significance |
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10. Risk factor for arrhythmias |
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