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 (RCE, Biliary, DVT, E-FAST, AAA) Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

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