Acute Chest Pain and Electrical Alternans
Maria Inês Barradas1, Fabiana Duarte1, Inês Coutinho Dos Santos1
1Hospital do Divino Espírito Santo de Ponta Delgada, Avenida D. Manuel I, Ponta Delgada, São Miguel, Portugal.
JACC. Case Reports
|December 14, 2023
Summary
A young man experienced chest pain and an abnormal electrocardiogram (ECG) finding called electrical alternans. This was caused by a rare condition: left-sided tension pneumothorax, a collapsed lung.
Area of Science:
- Cardiology
- Pulmonology
- Emergency Medicine
Background:
- Electrical alternans, a beat-to-beat variation in QRS amplitude on ECG, is typically associated with pericardial effusion.
- Tension pneumothorax, a life-threatening condition, involves air accumulation in the pleural space, leading to lung collapse and mediastinal shift.
Purpose of the Study:
- To report a rare case of electrical alternans caused by tension pneumothorax.
- To highlight the importance of considering uncommon etiologies for electrical alternans in emergency settings.
Main Methods:
- Case report of a young male patient presenting with acute chest pain.
- Diagnostic workup included 12-lead electrocardiogram (ECG), lung auscultation, and chest radiography.
Main Results:
- ECG demonstrated electrical alternans with significant QRS amplitude variation.
- Physical examination revealed absent breath sounds on the left side.
- Chest X-ray confirmed a left-sided tension pneumothorax.
Conclusions:
- Tension pneumothorax can present with electrical alternans, a finding usually attributed to other causes.
- This case underscores the need for a broad differential diagnosis in patients with electrical alternans and acute chest pain.
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Introduction
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
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Parts of an ECG
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