Total Electrical Alternation in Pericardial Disease

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Abstract
Simultaneous electrical alternation of atrial and ventricular components can occur in malignant and sometimes tuberculous pericardial disease and is due, apparently, to a rotary pendular movement of the heart at a rate that differs from the pulse. This oscillation occurs only during effusion with tamponade and clears with paracentesis. It is thought to be the result of unusual freedom or release from the normal pulmonary and thoracic restraints.