Electrical alternans in cardiac tamponade

Of nine patients with pericardial effusion due to various causes, four developed cardiac tamponade. Electrical alternans was present in all four, being total in three and ventricular in one. The alternans corresponded very well with the clinical diagnosis of cardiac tamponade and the radiological si...

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Bibliographic Details
Published in:Thorax 1975-04, Vol.30 (2), p.228-233
Main Author: Niarchos, A P
Format: Article
Language:English
Subjects:
Adult
Aged
Cardiac Tamponade - diagnosis
Cardiac Tamponade - physiopathology
Drainage
Electrocardiography
Female
Heart Rate
Humans
Male
Middle Aged
Pericardial Effusion - physiopathology
Pericardial Effusion - therapy
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Summary:Of nine patients with pericardial effusion due to various causes, four developed cardiac tamponade. Electrical alternans was present in all four, being total in three and ventricular in one. The alternans corresponded very well with the clinical diagnosis of cardiac tamponade and the radiological signs of a large pericardial effusion. In two patients alternans was present even with heart rates below 100 per minute. Apart from the exact (1 : 1) type of electrical alternans, three new types are described, a 2 : 1, 3 : 1, and a varying type. It is concluded that (a) electrical alternans associated with pericardial effusion is strongly suggestive of impending or established cardiac tamponade, and (b) electrical alternans is produced when the heart is oscillating within the pericardial sac distended by fluid with a frequency equal to one-half (exact alternans), one-third (2 : 1 alternans), and one-quarter (3 : 1 alternans) of the heart rate. The aetiology and mechanism of electrical alternans are discussed.
ISSN:0040-6376
1468-3296
DOI:10.1136/thx.30.2.228