electrical alternans
{{Infobox medical condition (new)
| name = Electrical alternans
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| image = Electrical Alternans.JPG
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| caption = Electrical alternans, tachycardia, and low voltage in a person with a large pericardial effusion.
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| field = Cardiology
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Electrical alternans is an electrocardiographic phenomenon of alternation of QRS complex amplitude or axis between beats and a possible wandering base-line. It can be seen in cardiac tamponade and severe pericardial effusion and is thought to be related to changes in the ventricular electrical axis due to fluid in the pericardium, as the heart essentially wobbles in the fluid filled pericardial sac.{{cite book|title=Clinical Arrhythmology|author=Antonio Bayés de Luna|publisher=John Wiley and Sons|year=2011|page=351|url=https://books.google.com/books?id=imwpNCqooDQC&dq=electrical+alternans&pg=PA351|isbn=9781444391732}} It can also be found in other conditions, such as bidirectional ventricular tachycardia from digoxin toxicity {{Cite web |title=Electrical Alternans Differential Diagnoses |url=https://emedicine.medscape.com/article/154706-differential |access-date=2024-12-12 |website=emedicine.medscape.com |language=en}} and atrioventricular tachycardia. {{Cite journal |last=Amasyali |first=Basri |last2=Kose |first2=Sedat |last3=Çelik |first3=Turgay |date=2006-02-01 |title=Atrioventricular nodal re-entrant tachycardia with QRS voltage and cycle length alternation and aberrant conduction due to two distinct antegrade slow pathways |url=https://academic.oup.com/europace/article/8/2/134/439010 |journal=EP Europace |volume=8 |issue=2 |pages=134–137 |doi=10.1093/europace/euj033 |issn=1099-5129}}
The echocardiogram of the heart demonstrated the characteristic swinging along with alternating voltage on the ECG.{{cite journal | last1=Jehangir | first1=Waqas | last2=Osman | first2=Mohamed | title=Electrical Alternans with Pericardial Tamponade | journal=New England Journal of Medicine | volume=373 | issue=8 | date=2015-08-20 | issn=0028-4793 | doi=10.1056/NEJMicm1408805 | page=e10| pmid=26287870 }}
Causes
The two most common causes of electrical alternans are cardiac tamponade and pericardial effusion. In this case, the heart's pendulum-like motion and rotation from beat to beat, which the ECG electrodes detect as varying amplitudes, is what causes the classic ECG rhythm. In addition, electrical alternans can be observed in conduction and refractory changes in a variety of rhythms, including the ones previously mentioned, which causes the electrodes to detect a range of QRS amplitudes.{{cite web | last1=Ingram | first1=David | last2=Strecker-McGraw | first2=Margaret K. | title=Electrical Alternans | publisher=StatPearls Publishing | date=April 7, 2023 | pmid=30480962 |url=https://www.ncbi.nlm.nih.gov/books/NBK534229/ | access-date=December 29, 2023}}
See also
References
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Further reading
- {{cite journal | last1=M | first1=Goyal | last2=KM | first2=Woods | last3=JE | first3=Atwood | title=Electrical alternans: a sign, not a diagnosis | journal=Southern Medical Journal | date=August 2013 | publisher=South Med J | volume=106 | issue=8 | pages=485–489 | issn=1541-8243 | pmid=23912146 | doi=10.1097/SMJ.0b013e3182a1456c | s2cid=19681969 |url=https://pubmed.ncbi.nlm.nih.gov/23912146/ | access-date=December 29, 2023 | ref=none}}
- {{cite book | last=Mittal | first=Sitaram | title=Insights into Electrocardiograms with MCQs | chapter=Electrical Alternans | publisher=Springer Nature Singapore | publication-place=Singapore | date=2023 | pages=681–684 | isbn=978-981-99-0126-5 | doi=10.1007/978-981-99-0127-2_47 | ref=none}}
External links
{{Medical resources
| ICD11 = {{ICD11|MC81.Y}}
| ICD10 = {{ICD10|R00.8}}
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| ICD9 = {{ICD9|785.3}}
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| DiseasesDB = 30762
| SNOMED CT = 423863005
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| eMedicineSubj = article
| eMedicineTopic = 154706
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{{Heart diseases|state=collapsed}}
{{DEFAULTSORT:Electrical Alternans}}