Pulsus alternans induced by spinal anesthesia

Pulsus alternans is attributed to an alteration of the stroke volume with every other cardiac cycle, and reduced venous return is considered an important causative factor. Tachycardia can exacerbate this process as diastolic filling becomes further impaired. During pulsus alternans, increased end-diastolic volume can increase wall stress, which further reduces systolic performance [1], making appropriate treatment essential, even if the patient shows no signs or symptoms of heart failure.

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