Acoustic, Mechanical and Electric Alternans in Hemopericardium of Occult Leukemic Origin

¹ Director, Cardiovascular Department
² Department of Cardiovascular Diseases, Red Cross General Hospital, Athens, Greece
³ Senior Clinical Instructor, Department of Cardiology

Alternation of the first heart sound in intensity, associated with mechanical and electric alternans is reported in a patient with large hemorrhagic pericardial effusion. The significance and pathogenesis of this combination of clinical features are discussed. Following three pericardiocenteses and removal of 1,500 milliliters of fluid, all alternation phenomena disappeared. Of clinical importance was the failure to obtain evidence of leukemia in consecutive smears. Pericardiectomy, performed on the 90th day of the disease, resulted in alleviation of the symptoms. Leukemia was demonstrated on the 120th day of the disease.