Abstract

Among clinical signs of left ventricular (LV) systolic dysfunction, “pulsus alternans” (PA) has been well described and analyzed in terms of its pathophysiology, representing beat-to-beat variation of ejected volume, despite a similar electrical activation sequence and diastolic times, constituting a phenomenon of chaotic and impaired ejection. It involves the entire cardiac cycle, as demonstrated by echocardiography. A dramatic sign of systolic dysfunction could be called failed ejection (FE) and represents the inability of the left ventricle to generate pressure that exceeds that of the ascending aorta, failing to open the aortic valve and to generate an effective (ejected) systolic volume. This can be observed in patients with advanced heart failure connected to LV assist devices and in the presence of systolic aortic regurgitation (SAR), being preceded by a premature ventricular complex (PVC). These findings are associated with heart failure, and its prognostic contribution, except for PA, has not been convincingly demonstrated to date. In this article we report a patient who presented FE not related to the triggers previously described (i.e., not an extrasystolic phenomenon), with electrically normal systolic activation, which we refer to as “phantom systole.”