Electrical alternans: Case report and comments on the literature

Electrical alternans in cardiac tamponade.

“…been estimated as varying between 1 in 1,212 and 1 in 10,000 tracings (Hamburger et ail., 1936;Kalter and Schwartz, 1948). To date about 80 cases, including the present four, have been reported in the literature (Brody and Rossman, 1937;McGregor and Baskind, 1955;Colvin, 1958;Usher and Popp, 1972). In two-thirds of the reported cases the alternans was due to cardiac tamponade caused by malignant haemopericardium or by massive pericardial effusion.…”

“…Finally, all main complexes (P-QRS-T) may alternate simultaneously when the phenomenon is called total electrical alternans (Littmann and Spodick, 1958;Brody et al, 1973). Although ventricular and total electrical alternans are not very common they are of clinical interest because they occur primarily in association with massive pericardial effusion and cardiac tamponade (McGregor and Baskind, 1955;Colvin, 1958;Littmann and Spodick, 1958;Spodick, 1962;Bashour and Cochran, 1963;Lawrence and Cronin, 1963;Gabor, Winsberg, and Bloom, 1971;Usher and Popp, 1972;Brody et al, 1973).…”

Left atrial tamponade.

“…may be of some help in differentiating the two conditions. Total electrical alternans has been described in some cases of cardiac tamponade and is thought to be diagnostic (Traut, 1950;McGregor and Baskind, 1955;Colvin, 1958 ;Goley and Schwartz, 1958 , 1958;Strom, 1959;Curren, 1961 Lawrence andCronin, 1963). This differs from the usual type of electrical alternans, which classically occurs with myocardial disease, in that it involves both the P and QRS vectors, causing a shift of both vectors in the same direction every second beat.…”

Alternans in human atrial monophasic action potenial.

“…Reviews of further cases have been made by Hamburger et al (1935), Spang (1957), Colvin (1958), Schamroth et al (1959), Chung et al (1964), and Bellet (1971). Alternation of the P waves has been described by Bernreiter (1956), Kisch (1949), and Piso (1956).…”