Both the ECG (top) and the two-dimensional echocardiogram (bottom) of a 44-year-old woman with shortness of breath and metastatic carcinoma of unknown primary demonstrate the presence of pericardial tamponade. Top, A 12-lead ECG shows variation in the morphology of the QRS complex with every other electrical depolarization (electrical alternans). Bottom left, An apical four-chamber view shows a large pericardial effusion (PE). There is diastolic inversion of the right atrium (RA) (arrow). The apex of the heart is anterior and shifted to the right. A negative deflection in the QRS complex is recorded on the ECG (arrowhead). Bottom right, An apical four-chamber view, photographed at the QRS complex one cardiac cycle later shows that the heart has moved in a lateral and posterior direction. A positive deflection in the QRS complex is recorded on the ECG (arrowhead). The echocardiogram shows that excessive cardiac motion and beat-to-beat variation in right ventricular stroke volume alter the electrical axis, resulting in electrical alternans.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner, MC 4-265, Houston, TX 77030.
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