ECG Findings in Massive Pericardial Effusion

Massive pericardial effusion produces a characteristic ECG triad of:


Electrical alternans
  • Consecutive, normally-conducted QRS complexes that alternate in height
  • Occurs when the heart swings backwards and forwards within a large fluid-filled pericardium
ECG_massive_pericardial_effusion
Electrical alternans: Alternating QRS complex height best seen in lateral precordial leads

Management

Patients with this ECG pattern need to be immediately assessed for clinical and echocardiographic evidence of tamponade.


Examples
Example 1
Alternating QRS amplitude and axis
Alternating QRS amplitude and axis. Mugmon 2012

References

Advanced Reading

Online

Textbooks


LITFL Further Reading

ECG LIBRARY 700

ECG LIBRARY

Electrocardiogram

Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

MBBS (UWA) CCPU Emergency Medicine Advanced Trainee based in Melbourne, Australia. Co-author of the LITFL ECG Library. Likes Ultrasound, Echo, ECGs, and anything and everything with caffeine. Part of the 2021 ANZCEN Clinician Educator Incubator Programme | @rob_buttner | ECG Library |

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