Murmur Alternans in Aortic Stenosis

We have presented a case of severe aortic stenosis with pulsus alternans manifesting alternation of the auscultatory findings, namely, the systolic ejection murmur, diastolic gallop sound, first and second heart sounds and ejection click. Physiologic considerations are discussed. In the presence of a regular heart rate, alternating auscultatory findings have the same clinical significance as the finding of pulsus alternans.