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March 1958

Disappearance of Electrical Alternans Following Pericardiocentesis

Author Affiliations

New Haven, Conn.

Intern in Medicine (Dr. Goley) and Assistant Resident in Medicine (Dr. Schwartz), Grace-New Haven Community Hospital.

AMA Arch Intern Med. 1958;101(3):577-581. doi:10.1001/archinte.1958.00260150065008

Electrical alternans is a regularly occurring variation in amplitude configuration, or direction of one or more of the components of the electrocardiogram. Those components which represent ventricular activity are most frequently involved, while P-wave alternation is unusual.1,7,11,12,17 Alternation of the QRS and T complexes may occur alone or in combination with each other. This electrocardiographic abnormality is apparently rare. Hamburger, Katz, and Saphir7 saw only one example of it in 10,000 electrocardiograms; Feldman5 observed one instance in over 6000 electrocardiograms.

The following is a report of electrical alternans occurring in association with cardiac tamponade secondary to malignant involvement of the pericardium.

Report of a Case  A 34-year-old railroad worker was admitted to the Grace-New Haven Community Hospital on Jan. 22, 1957, because of an episode of syncope.He was apparently well until three months prior to admission, when he consulted his physician because of a dull boring

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