Question 30.1
This is the ECG of a 62-year-old man undergoing treatment for acute lymphoblastic leukaemia who presented with shortness of breath.
- What are the abnormalities on this ECG?
- What is the likely cause of his symptoms?
College Answer
a)
Atrial fibrillation
Low voltage complexes
Electrical alternans
b)
Pericardial effusion
Discussion
This of course is not the canonical CICM ECG, it is one which I found by Googling "AF with electrical alternans". Thus, the complexes are not actually "low volage". The presence of alternans is obscured by the irregularity of the AF, but it is still present, particularly if you look at leads V1 and V2.
In ideal conditions, electrical alternans should look like this:
If the rightful owner of this image ever comes forward and demands I take it down, I will be forced to generate this electrical phenomenon in myself.
References
Usher, Bruce W., and Richard L. Popp. "Electrical alternans: Mechanism in pericardial effusion." American heart journal 83.4 (1972): 459-463.