Pericardial effusion, pericarditis, electrical alternans

Patient

69-year-old man treated by chemotherapy for bronchial adenocarcinoma; hospitalized for major dyspnea with hypotension;

Trace

This tracing shows a sinus tachycardia and an electrical alternans of the QRS-complexes (alternans between 2 QRS of different morphology and amplitude); low QRS voltage in limb leads and precordial leads; A cardiac ultrasound revealed a substantial pericardial effusion (2 cm circumference) with a swinging heart pattern explaining the electrical alternans pattern; pericardial puncture by the sub-xyphoidal route allowing to evacuate 750 ml;

Trace

Tracing recorded after the puncture; resolution of the electrical alternans pattern;

Exergue

The association between sinus tachycardia and electrical alternans of QRS, P-wave and/or T-wave patterns should point to a diagnosis of abundant pericardial effusion.