Abstract
Pulsus alternans (PA), reported in nineteenth century, is a subtle abnormality, often missed in emergency situations. However, the significance lies in its association with severe ventricular dysfunction. This case reports an 8-year-old child presenting with heart failure in emergency department. Abdominal aortic Doppler displayed pulsus/Doppler alternans. Step by step investigation of Doppler clue unearthed severe left ventricular dysfunction secondary to systemic arterial hypertension.
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