Electrical alternans in cardiac tamponade.

Niarchos, Andreas P.

doi:10.1136/thx.30.2.228

Cited by 24 publications

(10 citation statements)

References 22 publications

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“…As to QRS alternans, it has not been shown to be predictive of tamponade in one series [8], while in another one it was more commonly seen [30]. In our study, it was detected only in 5 of patients, all of them had PRsd.…”

Section: Discussioncontrasting

confidence: 43%

“…In our study, it was detected only in 5 of patients, all of them had PRsd. There might be missing non-detected cases, and several mechanisms have been proposed as rigidity of pericardial sac, viscosity of the pericardial content, excessive cyclic pendular and rotational motion of heart within pericardial sac, as well as large effusion [30,32,33]. The higher rate of purulent content, diffuse effusion and calcification, consequences of mechanical compression might be contributing factors in our patients as well.…”

Section: Discussionmentioning

confidence: 78%

“…Association of PRsd with low voltage QRS and QRS alternans may be explained by presence compression (tamponade and constriction) and inflammation [29][30][31]. Low voltage QRS was described in 55-89% of patients with constrictive pericarditis [6,31] and was found to be an independent predictor of tamponade in patients with moderate and large pericardial effusions (OR 4.7, 95% CI 1.1-21) [8].…”

Section: Discussionmentioning

confidence: 95%

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Electrocardiographic abnormalities in patients with pericardial disease — Association of PR segment depression with arrhythmias and clinical signs: Experience of cardiac surgery center

Kudaiberdiev¹,

Джумагулова

Joshibayev³

et al. 2016

Journal of Electrocardiology

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Section: Discussioncontrasting

confidence: 43%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 95%

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Electrocardiographic abnormalities in patients with pericardial disease — Association of PR segment depression with arrhythmias and clinical signs: Experience of cardiac surgery center

Kudaiberdiev¹,

Джумагулова

Joshibayev³

et al. 2016

Journal of Electrocardiology

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“…It can broadly be classified into three types depending on which part of the ECG is affected 5 6. Repolarisation alternans involves T or ST segments.…”

Section: Discussionmentioning

confidence: 99%

The importance of an ECG: back to basics

2012

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A 48-year-old man presented to accident and emergency with syncope on a background history of 3 weeks of increasing shortness of breath. He collapsed at home prompting admission. He was a smoker with a 30-pack-year history. On examination, he was found to be tachypnoeic and hypoxic, with a raised JVP and quiet heard sounds. He was haemodynamically stable and a chest x-ray showed right upper-lobe collapse.His resting ECG demonstrated electrical alternans prompting urgent referral to the cardiologist for echocardiography. This revealed a large pericardial effusion with evidence of right ventricular diastolic collapse. In view of this, he underwent urgent pericardiocentesis.A subsequent CT scan showed bilateral pleural effusions and multiple lung nodules. Both pericardial and pleural fluid cytology were reported as metastatic non-small cell adenocarcinoma. The pericardial fluid continued to reaccumulate requiring a pericardial window. He was referred to the oncology team for palliative chemotherapy. BACKGROUND

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“…For example, pericardial effusions and cardiac tamponade can be evidenced on ECG as electric alternans, wherein the amplitude and vector of successive P waves, QRS complexes, and T waves alternate as the heart swings back and forth in the fluid-filled pericardium ( Figure 6). [33][34][35] In addition to the aforementioned bundle-branch blocks that can develop after IMHs and to the ST-segment changes that can result after coronary injury, it is worth noting that an association between traumatic tricuspid injury and heart block (ranging from first to third degree) has also been reported. 36 Here, too, therapy is dictated by the accepted standards of care for the given block and should occur in conjunction with any possible tricuspid valve procedure.…”

mentioning

confidence: 99%

Common Cause of Mortality in Trauma but Manageable Nonetheless

et al. 2015

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Foreword Information about a real patient is presented in stages (boldface type) to expert clinicians (Drs Eachempati and Salemi), who respond to the information, sharing their reasoning with the reader (regular type). A discussion by the authors follows.A n obese but otherwise healthy 53-year-old man was unloading a delivery van when he was struck from behind by a slow-moving garbage truck, pinning him between the 2 vehicles. The patient was lying supine on the ground when emergency medical services arrived. He was alert and oriented with a Glasgow Coma Scale score of 15. The patient was complaining of pain in his right upper extremity and numbness in his left foot. His initial vital signs were notable for a heart rate of 100 bpm; his blood pressure was 150/90 mm Hg; and his breathing was elevated at 22 breaths per minutes. The patient denied loss of consciousness and had no neck, back, or chest pain. Per emergency medical services, the patient's midchest appeared erythematous and his left lung field was coarse on auscultation, and he had a small abrasion on his left knee. The rest of his in-the-field examination was unremarkable. A cervical collar was placed, and the patient was placed on a back-board for transport. The patient's vital signs remained stable en route per the emergency medical services' report, although he became increasingly anxious and repeatedly removed both his cervical collar and a nonrebreather mask that had been placed empirically.On arrival in our trauma bay, the patient was found to be in shock: pulse rate, 129 bpm; blood pressure, 69/51 mm Hg; respiratory rate, 20 breaths per minute; and O 2 saturation, 80% on room air. He remained awake with a Glasgow Coma Scale score of 15 but now was complaining of difficulty breathing and of right-sided chest and back pain. His primary survey was notable for rhonchorous breath sounds bilaterally and right-sided chest wall crepitus; his abdomen was soft and had no peritoneal signs. The patient remained tachycardic, but his blood pressure improved to 127/113 mm Hg as 2 L crystalloid and 1 U red blood cells were given in bolus. His O 2 saturation improved to 96% on a nonrebreather mask providing O 2 at 15 L/min. His initial ECG demonstrated sinus tachycardia with questionable electric alternans in leads V 1 and V 5 (Figure 1). The patient's focused assessment with sonography for trauma (FAST) examination was unremarkable. A chest radiograph revealed extensive right subcutaneous emphysema, multiple right lateral rib fractures, a small rightsided apical pneumothorax, and bilateral patchy opacities consistent with pulmonary contusion or hemorrhage. His cardiomediastinal silhouette was normal (Figure 2A). A pelvic radiograph was negative for injury. A right chest tube was inserted with minimal serosanguinous output ( Figure 2B), and a Foley catheter was placed.Dr Eachempati: Care of traumatically injured patients demands the participation of various members of a large, interdisciplinary team and, depending on local practice, can involve surgeons, emergenc...

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Electrical alternans in cardiac tamponade.

Cited by 24 publications

References 22 publications

Electrocardiographic abnormalities in patients with pericardial disease — Association of PR segment depression with arrhythmias and clinical signs: Experience of cardiac surgery center

Electrocardiographic abnormalities in patients with pericardial disease — Association of PR segment depression with arrhythmias and clinical signs: Experience of cardiac surgery center

The importance of an ECG: back to basics

Common Cause of Mortality in Trauma but Manageable Nonetheless

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