Concomitant Systolic and Diastolic Doppler Alternans: An Ominous Sign of Left Ventricular Dysfunction

Pulsus alternans, defined by an arterial pulse alternating between strong and weak beats, often signify severe left ventricular dysfunction. Detectable on physical examination or by echocardiography, this phenomenon highlights substantial cardiac compromise. We discuss a case involving a 59-year-old male with non-ischemic cardiomyopathy who was admitted for acute congestive heart failure. The echocardiogram revealed severe left ventricular dysfunction with systolic and diastolic beat-to-beat variations in blood flow on Doppler, a phenomenon known as Doppler alternans. Notably, these echocardiographic findings preceded any clinical signs, leading to a timely escalation in care. This case emphasizes the critical role of echocardiography in assessing ventricular function and providing prognostic insights that can influence management strategies.