<prompt> Pulsus alternans is seen inSevere ventricular dysfunctionHOCMASCP  <response>: Pulses alterans is defined by beat-to-beat variability of pulse amplitude.It is seen in patients with severe left ventricular dysfunction and systolic hea failure,and is thought to be due to cyclic changes in intracellular calcium and action potential duration. Hyperophic obstructive cardiomyopathy is characterised by jerky pulse pulses bisferens. Aoic stenosis is characterised by slow rising carotid pulse.pulses parvus et tarsus AS may also have anacrotic pulse Harrisons Medicine-20 the edition. 