Introduction
An ECG or an electrocardiogram is a device that documents the electrical impulses of the heart. It is a ubiquitous diagnostic tool widely used for getting to the root of multiple heart conditions. It is an easy, painless, and quick test. The essential parts of an electrocardiogram are the P wave, T wave, and QRS complex. Depolarization of the heart refers to the standard transfer of electrical currents in the correct pattern through the heart muscles. The heart is divided into chambers. The two upper sections are called the left and right atrium. The lower divisions of the heart are called the left and right ventricles.
The P wave designates atrial depolarization. The T wave, which comes after the QRS complex, represents ventricular repolarization. Depolarization is when the cardiac muscles (heart muscles) are relaxed. The QRS complex has the Q wave, R wave, and S wave that indicate ventricular depolarization. Electrical alternans are linked with many cardiovascular conditions such as ventricular tachycardia, pericardial effusion, supraventricular tachycardia, etc. Recognizing and identifying the underlying conditions and pathologies that show the respective electrocardiogram findings is critical in treatment and management planning. Electrical alternans can be easily visualized in an electrocardiogram.
What Are the Causes of Electrical Alternans?
Electrical alternans are the change in voltage of the QRS complex and are visible in the electrocardiograph.
Below are some of the causes of electrical alternans.
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Pericardial effusion and cardiac tamponade are the two most common reasons that lead to electrical alternans.
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Pericardial effusion is a condition where the pericardium is filled with fluid. The pericardium is the sac-like double-layered protective covering of the heart.
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Cardiac tamponade is when the heart gets highly compressed due to fluid accumulation. Electrical alternans are also visible in conditions where the conduction and refraction of the heart are altered.
Other causes of electrical alternans are underlying myocardial or systemic conditions such as pneumothorax, emphysema, pleural effusions, etc. Cardiovascular diseases leading to electrical alternans include atrioventricular nodal reentry tachycardia, bundle branch block, late premature ventricular complex, etc. It has also been studied and proven that deep breathing and inhalation during a panic attack or nervous breakdown further leads to electrical alternans.
What Are the Signs and Symptoms of Electrical Alternans?
An electrocardiograph will specify the presence of electrical alternans. Nevertheless, there are some clinical manifestations that a patient may show.
Below are some of the signs and symptoms of electrical alternans.
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Muffled heart sounds.
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Neck veins that are distended.
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Light-headedness.
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Lethargy and fatigue.
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Chest pain or chest discomfort.
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Arrhythmias or irregular heartbeats.
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Abnormal rapid breathing.
How to Diagnose Electrical Alternans?
Recording any family history of cardiovascular conditionals as well as cardiac history is very crucial in the diagnosis of electrical alternans. Electrocardiography is an evident and vital diagnostic tool. In addition to electrocardiography, further evaluation is also recommended. Another modality of imaging the heart is TTE or transthoracic echocardiography. Transthoracic echocardiography is a highly sensitive procedure and is the suggested diagnostic tool for unstable patients.
How Are Electrical Alternans Treated?
The best way to manage a case of electrical alternans is by curing the underlying cardiovascular condition. Serious cardiac or systemic conditions that are present and are showing symptoms in the patient need to be managed first.
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Intravenous (IV) administration of necessary drugs, oxygen therapy, and other vitals and cardiac condition monitoring comprise the critical resuscitative measures.
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Faulty hemodynamics need to be corrected by filling malfunctioning heart chambers.
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Certain cardiovascular diseases, such as tamponade, need exact treatment, such as pericardiocentesis.
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Patients who have undergone a cardiac arrest or who are on the edge of developing a cardiac arrest may need to undergo immediate emergency treatment.
Such prompt treatments may seldom be invasive. Once the patient is stabilized, the necessary investigation that may help determine the root cause of determination can be carried out. Electrical alternans are distinguished from mechanical alternans such as pulsus alternans, but it should be noted that they both may coexist. Overall, the best treatment modality and management choice are to primarily understand and diagnose the cause of the ongoing underlying cardiovascular condition and resolve it; this will, in turn, help treat electrical alternans.
What Are the Complications of Electrical Alternans?
A patient may develop no specific complications or risks if there is a finding of electrical alternans in the patient's electrocardiograph. But instead, the main reason for developing complications is untreated and ignored underlying cardiovascular disease. Thus, it is vital for patients with a history of cardiac disorders, a family history of heart conditions, or patients who are already under treatment for any cardiovascular disease to follow up with their healthcare providers regularly and get their heart monitoring done without fail. This will reduce the complications and risks that may arise and detect any electrical alternans if present at an early stage. Early diagnosis results in early treatment and a better outcome without disturbing the quality of life. It should also be kept in mind that patient education is extremely necessary to avoid complications.
Conclusion
Electrical alternans is not a diagnostic factor for all cardiovascular diseases but is an excellent diagnostic tool presenting specific pathologies in the electrocardiograph findings. Early diagnosis and evaluation of the patient with electrical alternans, along with the continuous monitoring of the patient's vital signs, are imperative. Electrical alternates are not an individual pathology or a condition. But instead, it is a warning sign of the underlying cardiovascular disease that needs to be addressed. Once the infection is treated, electrical alternans are expected to not be present in the future electrocardiogram reading.
