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A patient with massive pericardial effusion and electrical alternans was studied. Intravenous administration of 8 mg practolol produced a decrease in heart rate from 120 to 87 beats/min, with increase of the alternans. The postulation that tachycardia is necessary for the appearance of electrical alternans in cardiac tamponade cannot be supported from this finding.

Augmentation of Electrical Alternans with Lowering of the Heart Rate in Massive Pericardial Effusion