AHA diet recommendations.

average for alternating pairs is also remarkably close to the ratio of the control beat. In other words, one of the paired beats is actually greater than average in its index of performance, and one is less. This observation in dogs, plus the widely recognized effects of potentiation in the postextrasystolic beat, make a strong case for potentiation alternating with deletion as the mechanism of pulsus alternans. This averaging has some clinical consequences. Paired, pulsed stimulation is no longer used for increasing cardiac performance, but it should be apparent from inspection of figures 5 and 6 that the patient does not actually deteriorate from alternation, although alternation is likely to occur in patients with compromised myocardium. The alternation is not a dangerous condition , and a specific intervention is not required to eliminate it, although the clinician may wish to treat the underlying myocardial disorder. Again, the separation between the cause and effect should permit the clinician to consider the long-term health of the patient's myocardium, rather than rushing to abolish a phenomenon that is not particularly disadvantageous. References 1. Hada Y, Wolfe C, Craige E: Pulsus alternans determined by biven-tricular simultaneous systolic time intervals.