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Electrical Alternans
- Prof.M.K.Sudhakarsunit
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29 yr , male pt
No comorbidities
C/o cough with expectoration 1 mth
Dyspnea 15 days progressed from grade 2 to 4
No other associated complaint
O/E : Conscious, oriented, afebrile, tachypneic
PR 116/mt, BP 110/70 mmhg
CVS s1 , s2 +, no murmurs
RS NVBS +, B/L basal crepts
Abd soft , BS +
CNS - NFND
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Labs
Hb/Plat - N
Tc 23170 (p-84.1)
RBS/RFT/Sr.Elect N
LFT T.B - 1.53 / D.B - 0.65
SGOT - 27 / SGPT 96 ESR - 62
Urine R/e N
CxR(bedside) B/L LZ congestion, cardiomegaly,B/L CP
angle blunting BNP 45.8 pg/ml
ECG NSR , no ST-T changes
Outside echo normal LV function with no RWMA
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Pt was managed in ICU as CAP with
- O 2
- Antibiotics- other supportives
Blood, sputum & urine C/s no growth
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On day 2
Developed hypotention ECG in ICU monitor showed
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Cardiology opinion was sought from
Prof.S.Thanikachalam
Suspected to have pericardial effusion
Urgent Echo was done & found to have
massive pericardial effusion with swinging
heart
Around 750 ml pericardial fluid was drained
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Pericardial fluid analysis
Sugar 10 mgm/dl
Protein 5.3 gm/dl
WBC 32cells/cumm(P-80%,L-20%)
RBC 7400 cells/cumm(norm-80%,cren-20%)
ADA 64 IU/L
PCR TB negative
c/s no growth
AFB not seen
Cytology mesothelial cells
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Pt was started on ATT
Follow up echo showed very minimal
pericardial effusion
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Repolarization alternans
ST segment alternans :
Alternating ST elevation - usually in presenceof MI
Causes
Acute MI
Vasospastic angina pectoris
During PTCA
Subarachnoid haemorrhage
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T wave alternans : Associated with rapid changes in HR or prolonged QT
interval
Predictor of ventricular tachyarrythmias
Causes : Congenital long QT syndrome
Dyselectrolemia(hypocalcemia,hypokalemia,hypomagnesemia)
Hypertrophic cardiomyopathy
CCF
TPI
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Conduction alternans
Alteration in impulse propagation along any ofanatomic structures involved in conduction of electricalimpulse
Alteration of P/QRS complex/PR interval/RR interval
Causes:
Myocardial ischaemia
AF
WPW syndrome RHD
LV dysfunction
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Electrical alternans associated with
cardiac motion
Alteration in heart position in relation to
electrodes
Total electrical alternans
Causes:
Pericardial tamponade
Hypertrophic cardiomyopathyTotal electrical alternans 5 - 10 % of cardiac
tamponade cases
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Thank you