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MCQ 7: Electrical alternans

Q. Total electrical alternans is seen in ?
A. Large pericardial effusion
B. Pulmonary embolism
C. Congestive heart failure
D. Myocardial infarction
Answer: A 

 Explanation:
Electric alternans is seen in cardiac tamponade or massive pericardial effusion. It occurs due to swinging motion of heart in a large sac of fluid (Pericardial fluid). 
Electrical alternans must be distinguished from mechanical alternans (eg, pulsus alternans), although both may coexist. Pulsus altenans is most commonly seen in severe left ventricular systolic impairment and is suggestive of grim prognosis for the patient.
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