{"id":19043,"date":"2015-05-05T06:32:18","date_gmt":"2015-05-05T01:02:18","guid":{"rendered":"https:\/\/cardiophile.org\/?p=19043"},"modified":"2015-05-05T06:32:18","modified_gmt":"2015-05-05T01:02:18","slug":"electrical-alternans-in-pericardial-effusion","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/electrical-alternans-in-pericardial-effusion\/","title":{"rendered":"Electrical alternans in pericardial effusion"},"content":{"rendered":"<h2><span style=\"color: #008000;\">Electrical alternans in pericardial effusion<\/span><\/h2>\n<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/RG3gbmKqUdo\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<figure id=\"attachment_19044\" aria-describedby=\"caption-attachment-19044\" style=\"width: 1134px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2015\/05\/Electrical-alternans.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-19044 size-full\" src=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2015\/05\/Electrical-alternans.jpg\" alt=\"Electrical alternans\" width=\"1134\" height=\"553\" srcset=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2015\/05\/Electrical-alternans.jpg 1134w, https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2015\/05\/Electrical-alternans-300x146.jpg 300w, https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2015\/05\/Electrical-alternans-1024x499.jpg 1024w, https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2015\/05\/Electrical-alternans-768x375.jpg 768w\" sizes=\"auto, (max-width: 1134px) 100vw, 1134px\" \/><\/a><figcaption id=\"caption-attachment-19044\" class=\"wp-caption-text\">Electrical alternans in pericardial effusion<\/figcaption><\/figure>\n<p style=\"text-align: center;\"><em>ECG showing electrical alternans in pericardial effusion<\/em><\/p>\n<p style=\"text-align: left;\">Electrical alternans in pericardial effusion is due to swinging of the heart within the fluid filled pericardial cavity. QRS amplitude is larger when the heart is in the direction of the ECG lead axis and shorter when the heart is away. Low voltage QRS complexes are noted, with standard leads showing less than five millimeters of total QRS amplitude and chest leads showing less than ten millimeters of QRS amplitude. QRS electrical alternans is very evident in lead V1 with alternate QRS complexes being small and larger. Close scrutiny shows similar change in T wave amplitude as well. Alternans in P, QRS and T wave amplitudes is called as <em>electrical alternans totalis <\/em>or<em> total electrical alternans <\/em>[1,2], which is considered as diagnostic of large pericardial effusion.<\/p>\n<p style=\"text-align: center;\"><a href=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2015\/05\/Pericardial-effusion-swinging-of-heart.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-19052\" src=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2015\/05\/Pericardial-effusion-swinging-of-heart.jpg\" alt=\"Pericardial effusion - swinging of heart\" width=\"600\" height=\"263\" srcset=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2015\/05\/Pericardial-effusion-swinging-of-heart.jpg 600w, https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2015\/05\/Pericardial-effusion-swinging-of-heart-300x132.jpg 300w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\" \/><\/a><\/p>\n<p style=\"text-align: center;\"><em>Pericardial effusion &#8211; swinging of heart<\/em><\/p>\n<p style=\"text-align: center;\">PE: Pericardial effusion<\/p>\n<p style=\"text-align: left;\">Sequential frames from two dimensional echocardiography from apical four chamber view shows swinging of the heart to either side so that amount of pericardial fluid on either side varies with time. Such swings will produce electrical alternans on the electrocardiogram. The lead in which it will be more prominent depends on the orientation of the lead axis and the swing axis of the heart in the particular case. The swing will be quite well appreciated in real time echocardiography. This finding is almost always seen in large pericardial effusion with features of cardiac tamponade and needs urgent pericardial aspiration as a life saving procedure [2].<\/p>\n<p>Cineangiogram has also been used to demonstrate that electrical alternans is synchronous with and due to pendulous movement of the heart in the pericardial space [3].<\/p>\n<p style=\"text-align: left;\">Malignant effusion is the most common cause of cardiac tamponade. Traumatic bleed into the pericardium is another important cause of rapid collection of fluid in the pericardial cavity and cardiac tamponade.<\/p>\n<p><strong><span style=\"color: #0000ff;\">References<\/span><\/strong><\/p>\n<ol>\n<li>Sotolongo RP, Horton JD. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/7234665\/\">Total electrical alternans in pericardial tamponade<\/a>. Am Heart J. 1981 Jun;101(6):853-5.<\/li>\n<li>Verlaan D, Veltman JD, Grady B. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6058104\/\">Total electrical alternans in a patient with malignant pericardial tamponade<\/a>. BMJ Case Rep. 2018 Jul 19;2018:bcr2018224771.<\/li>\n<li>Rinkenberger RL, Polumbo RA, Bolton MR, Dunn M. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/647775\/\">Mechanism of electrical alternans in patients with pericardial effusion<\/a>. Cathet Cardiovasc Diagn. 1978;4(1):63-70.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Electrical alternans in pericardial effusion is due to swinging of the heart within the fluid filled pericardial cavity. QRS amplitude is larger when the heart is in the direction of the ECG lead axis and shorter when the heart is away. <\/p>\n","protected":false},"author":1,"featured_media":19044,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[6,7],"tags":[],"class_list":["post-19043","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ecg-electrophysiology","category-ecg-library"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Electrical alternans in pericardial effusion - All About Cardiovascular System and Disorders<\/title>\n<meta name=\"description\" content=\"Electrical alternans in pericardial effusion is due to swinging of the heart within the fluid filled pericardial cavity. 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