Lewis B S, Lewis N, Gotsman M S
Chest. 1979 May;75(5):634-6. doi: 10.1378/chest.75.5.634.
We describe a patient who had severe left ventricular dysfunction and pulsus alternans following an episode of severe viral myocarditis. Pulsus alternans was mild with the patient in the supine and squatting positions but increased dramatically on standing. Echocardiograms were used to study changes in left ventricular dimension and function with changes in posture. On standing, there was a decrease in the left ventricular diameter and an increase in the absolute and relative shortening fraction and the velocity of shortening on the strong beats, and there was a decrease in end-diastolic dimension and the measurements of ventricular contractility on the weak beats. The marked increase in pulsus alternans during standing may have been induced by increased sympathetic stimulation following the decrease in ventricular loading conditions, while the great beat-to-beat differences in end-diastolic dimension suggest, in addition, the importance of Starling's mechanism.
我们描述了一名患者，在经历严重病毒性心肌炎发作后出现严重左心室功能障碍和交替脉。患者仰卧和下蹲位时交替脉较轻，但站立时显著加重。使用超声心动图研究姿势改变时左心室大小和功能的变化。站立时，左心室直径减小，强搏动时绝对和相对缩短分数及缩短速度增加，而弱搏动时舒张末期内径和心室收缩性测量值减小。站立时交替脉显著增加可能是由于心室负荷条件降低后交感神经刺激增加所致，此外，舒张末期内径的逐搏差异很大表明了Starling机制的重要性。
