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Isolated left ventricular pulsus alternans; an echocardiographic finding in a patient with discrete subaortic stenosis and infective endocarditis.

Pulsus alternans, alternating weak and strong beat in the presence of stable heart rate and QRS complex, is generally accepted as a finding of physical examination. It is most often associated with moderate or severe heart failure (1). After the introduction of echocardiography to clinical practice, there has been some debate about whether all alternating contractions are reflected in peripheral pulses (2). In this report, we present a case of echocardiographically detected left ventricular alternans, which has not been reflected in peripheral pulse.