Electrical Alternans at 300/min
Report:
Supraventricular tachycardia 300/min
Electrical alternans
Comment:
At fast rates, electrical alternans has no connotation of cardiac failure. It can be quite transient: below (Fig 73a) is a trace at only slightly slower rate, without alternans.
The rhythm, in an adult, would almost certainly be flutter with 1:1 conduction. At two weeks, the likely diagnosis is an orthodromic atrio-ventricular reentrant tachycardia. Sustained tachycardia causes heart failure in infants as well as adults â the so-called tachycardiomyopathy.
Further on (Fig 73b) is the patient in sinus rhythm. He was cardioverted with digoxin and adenosine.
73a.
73b. Sinus rhythm 130/min. Normal trace. 74. 26 year old lady with Carneyâs syndrome
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