TY - JOUR
T1 - Total electrical alternans in a patient with malignant pericardial tamponade
AU - Verlaan, Diede
AU - Veltman, Joris D.
AU - Grady, Bart
PY - 2018/7/19
Y1 - 2018/7/19
N2 - We present a case of a 59-year-old man with acute abdominal pain and progressive shortness of breath. A focused assessment with sonography for trauma scan showed free fluid in the hepatorenal recess and in the recto-uterine recess. Later, due to clinical deterioration and the differential possibility of a pulmonary embolism or aortic dissection, a CT scan was performed which revealed large pericardial effusion. This, together with a dilated vena cava inferior and portal system, raised the suspicion of cardiac tamponade. The diagnosis was confirmed by transthoracic echocardiography (TTE). In retrospect, the ECG at admission showed a sinus tachycardia, low-voltage QRS complexes and a total electrical alternans corresponding with the swinging heart seen on TTE. An electrical alternans on ECG is an important diagnostic clue but is often missed, causing an unnecessary delay to proper diagnostic and therapeutic measures.
AB - We present a case of a 59-year-old man with acute abdominal pain and progressive shortness of breath. A focused assessment with sonography for trauma scan showed free fluid in the hepatorenal recess and in the recto-uterine recess. Later, due to clinical deterioration and the differential possibility of a pulmonary embolism or aortic dissection, a CT scan was performed which revealed large pericardial effusion. This, together with a dilated vena cava inferior and portal system, raised the suspicion of cardiac tamponade. The diagnosis was confirmed by transthoracic echocardiography (TTE). In retrospect, the ECG at admission showed a sinus tachycardia, low-voltage QRS complexes and a total electrical alternans corresponding with the swinging heart seen on TTE. An electrical alternans on ECG is an important diagnostic clue but is often missed, causing an unnecessary delay to proper diagnostic and therapeutic measures.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85051014272&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30030246
U2 - https://doi.org/10.1136/bcr-2018-224771
DO - https://doi.org/10.1136/bcr-2018-224771
M3 - Article
C2 - 30030246
SN - 1757-790X
VL - 2018
JO - BMJ Case Reports
JF - BMJ Case Reports
M1 - 224771
ER -