. Medical diagnosis for the student and practitioner. ugh occasionallypresent without other distinct signs of cardiac disease. In severe cases therhythm is essentially fetal (the tic tac rhythm). To the author it would seem wiser to consider this condition clinicallyas one standing wholly apart from flutter and fibrillation. ALTERNATING PULSE.—This represents usually very rapid rhythmicalternation of stronger with weaker beats, the variation and force beingoften imperceptible to the finger. It is best shown by the radial andcarotid tracings, and is sometimes beautifully clear in the electrocar
. Medical diagnosis for the student and practitioner. ugh occasionallypresent without other distinct signs of cardiac disease. In severe cases therhythm is essentially fetal (the tic tac rhythm). To the author it would seem wiser to consider this condition clinicallyas one standing wholly apart from flutter and fibrillation. ALTERNATING PULSE.—This represents usually very rapid rhythmicalternation of stronger with weaker beats, the variation and force beingoften imperceptible to the finger. It is best shown by the radial andcarotid tracings, and is sometimes beautifully clear in the electrocardiogram. It will be noted that the beats fall at regular intervals, the abnormalitybeing one of force only. It is especially common in cardiosclerosis, the terminal cardiac insuffi-ciency of interstitial nephritis and coronary sclerosis, and is frequently asso-ciated with paroxysmal tachycardia and with auricular flutter. In practice its immediate seriousness is largely dependent upon thequestion of attendant pulse rate. Impairedcontractility Fig. 269. ?Pulsus alternans. Rhythmic pulse, waves present in jugular tracing jugular, lower tracing radial; time }/$ sec. Significance of Associations.—If the alternation occurs in mere rapidheart (simple tachycardia) such as may arise temporarily from trivial causesand subside upon their removal, it may or may not indicate myocardial dis-ease or overstrain. If associated with paroxysmal tachycardia the signifi-cance and associations of that form of pulse acceleration, wThich is probably amanifestation of auricular flutter dominate the clinical picture. // it occurs in a heart beating at, or but slightly above, the normal rate, andespecially in persons of middle or advanced age, or in connection with knowncardiac disease, it is of serious Prognosticfactor. Rapid hearts. Moderate rate. 562 MEDICAL DIAGNOSIS Induced byexercise. A herald ofrfeath. The same is true of cases in which alternation o
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