Electrical alternans: A sign, not a diagnosis

Manju Goyal*, Kevin M. Woods, John E. Atwood

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

14 Scopus citations


Electrical alternans is an electrocardiographic phenomenon defined as an alternating amplitude or axis of the QRS complexes in any or all leads. It is most commonly associated with a large pericardial effusion and impending threat of cardiac tamponade; however, a literature review showed that this electrocardiographic finding can be seen in a variety of other clinical scenarios with varying etiologies and prognoses. Several electrocardiogram examples are presented with a brief review of the potential mechanisms and clinical significance and demonstrate that electrical alternans is more correctly considered an electrocardiographic sign, rather than a diagnosis, with a broad differential for potential etiologies. For some causes, the clinical significance is well known, but for others, further research is needed.

Original languageEnglish
Pages (from-to)485-489
Number of pages5
JournalSouthern Medical Journal
Issue number8
StatePublished - Aug 2013
Externally publishedYes


  • Accelerated idioventricular rhythm
  • Bidirectional ventricular tachycardia
  • Cardiac tamponade
  • Electrical alternans
  • Electrocardiogram
  • Pericardial effusion
  • Supraventricular tachcardia


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