Changes in QRS voltage in cardiac tamponade and pericardial effusion: reversibility after pericardiocentesis and after anti-inflammatory drug treatment

Bruch, Christian; Schmermund, Axel; Dagres, Nikolaos; Bartel, Thomas; Caspari, Guido; Sack, S.; Erbel, Raimund

doi:10.1016/s0735-1097(01)01313-4

Cited by 86 publications

(42 citation statements)

References 13 publications

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“…Although there was a significantly higher incidence of PE in these patients compared to those without low voltage, the presence of PE was not an independent variable related to low voltage in the multivariate analysis. Bruch et al [26] reported that not only the presence of large PE but also the inflammatory mechanisms contributed to the occurrence of low voltage. Therefore, our data are consistent with previous reports that serous pericardial fluid retention is not essential for the presence of low voltage on the surface ECG.…”

Section: Discussionmentioning

confidence: 99%

Link between Pericardial Effusion and Attenuation of QRS Voltage in Patients with Hypothyroidism

Yamanaka¹,

Kumon²,

Matsumura

et al. 2010

Cardiology

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Objectives: To determine the clinical correlates of peri- cardial effusion (PE) and a low-voltage electrocardiogram (ECG) in patients with primary hypothyroidism. Methods: ECG, echocardiography and blood tests, including thyroid function tests, were performed in 64 consecutive patients with primary hypothyroidism. Results: Twenty-four patients (38%) had PE and 16 patients (25%) had low voltage. To determine the important variables present in patients with hypothyroidism that may be related to PE, 3 variables (free T4, pulmonary artery systolic pressure and serum albumin) were used in the multivariate analysis. From the analysis, free T4 (odds ratio = 0.032) and pulmonary artery systolic pressure (odds ratio = 1.085) emerged as significant variables related to PE, whereas when 4 variables (free T4, serum albumin, pulmonary artery systolic pressure and PE) were used to determine the important variables related to low voltage, free T4 (odds ratio = 0.029) and serum albumin (odds ratio = 0.255) were the significant variables, but PE had no significant relation with low voltage (p = 0.424). Conclusions: In addition to its association with more severe thyroid hormone deficiency, the presence of PE was also associated with an increase in pulmonary artery pressure, whereas attenuation of QRS voltage was associated with lower colloid osmotic pressure in patients with hypothyroidism.

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Section: Discussionmentioning

confidence: 99%

Link between Pericardial Effusion and Attenuation of QRS Voltage in Patients with Hypothyroidism

Yamanaka¹,

Kumon²,

Matsumura

et al. 2010

Cardiology

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“…1 Limbs leads low voltage is not uncommon in clinical practice and its differential diagnosis includes conditions such as obesity, lung emphysema, pericardial effusion, hypothyroidism and amyloidosis. Low voltage of the precordial leads is less common than limbs leads voltage and might be a feature of cardiac tamponade 2 or appear temporarily after defibrillation or cardioversion. 3 Little is known about the prevalence of low voltage in patients with ascites.…”

Section: Introductionmentioning

confidence: 99%

Precordial low voltage in patients with ascites

et al. 2007

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Aims Electrocardiographic (ECG) changes in patients with ascites are not well studied. The aim of this study was to evaluate ECG changes in patients with ascites.Methods and results Prospective analysis of patients with ascites who were referred for paracentesis. Three ECGs were recorded before paracentesis. ECG 1 was a standard 12-lead ECG. For ECG 2 the precordial leads were placed 1 intercostal space (ICS) and for ECG 3, 2 ICS cranially. The sums (S) of the QRS in ECG1 were compared with ECG 2 and 3. In six patients the same ECG protocol was performed after removal of ascites. Ten hospitalized patients without ascites served as controls. Twenty patients with ascites were analysed. Limbs leads low voltage was present in 11 patients and precordial low voltage in four patients. Cranial placement of the precordial electrodes increased SQRS in all patients with ascites. The most prominent voltage changes appeared in the leads V4-V6 (þ62%). Paracentesis of ascites normalized precordial leads low-voltage, while limbs leads low voltage remained. Cranial placement of the precordial electrodes in patients without ascites decreases SV1-V6. Conclusion We describe a phenomenon of precordial voltage changes in patients with ascites, not reported in the literature yet. By placing the precordial electrodes 1 and 2 ICS cranially the voltage changes can be 'corrected' and this should be done in all patients prior to further diagnostic workup. Removal of the ascites normalizes the precordial leads low voltage.

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“…Baixa amplitude do QRS acontece na presença de derrame pericárdico, que melhora após pericardiocentese 189,190 . A alternância na morfologia ou amplitude do QRS está associada à pericardite com derrame pericárdico volumoso e sinais de tamponamento cardíaco 191 .…”

Section: Diretriz Brasileira De Miocardites E Pericarditesunclassified