Transient dobutamine-mediated pulsus alternans

Pulsus alternans, alternating weak and strong beats occurring in a heart be ating at a constant race, has most often been reported in patients with sev ere, end-stage heart failure. This patient with New York Heart Association functional class I heart failure developed pulsus alternans during the inot ropic stimulation of dobutamine that subsequently resolved in a time course consistent with dobutamine clearance. Thus, in the setting of mildly impai red myocardial contractility, the inotropic stimulus of dobutamine may prec ipitate the development of reversible pulsus alternans.