Low QRS voltage in cardiac tamponade: a study of 70 cases

Oliver, Clara; Marı́n, Francisco; Pineda, Javier; Luján, Juan; Climent, Vicente; Garcı́a, Amaya; Arrarte, Vicente; Sogorb, Francisco

doi:10.1016/s0167-5273(02)00024-4

Cited by 13 publications

(7 citation statements)

References 6 publications

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“…3,5 This could be related in part to the etiology, which unlike our patients, varied widely in other reports. 3,5 Little attention has been paid to changes in the P wave in pericardial effusion. It is stated that P-wave changes are not seen in pericardial effusion since there is little collection of fluid over the left atrium owing to the reflection of the pericardial sac.…”

Section: Angiologymentioning

confidence: 45%

“…Low QRS voltage was not seen with tamponade in chronic renal failure but was present in 60% with neoplasms. 5 Our report is based on large effusions as seen from the cardiothoracic ratio and initial aspirate (Table I) and the majority had tamponade. Apart from the heart rate, which was higher, and sinus rhythm, which was more frequent in tuberculosis pericarditis, the voltages were not different between the 2 groups.…”

Section: Discussionmentioning

confidence: 88%

“…4 Other reports suggest that the quantity of fluid and etiology influence the QRS voltage. 5 The etiology of pericardial effusions varies in different geographical areas. The etiology, duration before presentation, rapidity of accumulation, size of the effusion, pericardial thickness, and the extent of involvement of the subjacent epicardium are all likely to affect the ECG.…”

Section: Introductionmentioning

confidence: 99%

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The Electrocardiogram in Large Pericardial Effusion: The Forgotten “P” Wave and the Influence of Tamponade, Size, Etiology, and Pericardial Thickness on QRS Voltage

et al. 2004

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There are varying reports on the electrocardiogram in pericardial effusions. Some correlate low QRS voltage with tamponade and the size of the effusion while others do not. Low voltage also appears to vary with the etiology. There are no reports on the influence of pericardial thickness or changes in the P voltage. The authors studied 43 patients with large effusions of whom 26 had tuberculosis and the remaining had viral/idiopathic etiology. Pericardial thickness was measured at chest computed tomography. They found no correlation between the low QRS voltage and tamponade, size of the effusion, etiology, or pericardial thickness. Low voltage of the P wave and T-wave changes were more frequent than low QRS voltage.

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Section: Angiologymentioning

confidence: 45%

Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Electrocardiogram in Large Pericardial Effusion: The Forgotten “P” Wave and the Influence of Tamponade, Size, Etiology, and Pericardial Thickness on QRS Voltage

et al. 2004

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“…Oliver et al have suggested that the quantity of accumulated pericardial fluid and aetiopathogenetic mechanisms influence the QRS voltage. 10 Hypothyroidism is associated with increased capillary permeability and subsequent leakage of proteins into the interstitial space, resulting in pericardial effusion; however, tamponade is rare. 11 The ECG is initially used in patients suspected of having a PE.…”

Section: Discussionmentioning

confidence: 99%

Down syndrome associated with hypothyroidism and chronic pericardial effusion: echocardiographic follow-up

Said

Droste²,

Derks³

et al. 2007

NHJL

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We present a 39-year-old male patient with Down syndrome who was evaluated for fatigue, palpitations and bouts of cyanosis. Physical examination showed features of trisomy-21(Down syndrome), with a slow pulse rate, distant cardiac sounds and absent apex beat. He had normal jugular venous pressure without pulsus paradoxus. The ECG showed QRS microvoltage and flattened P and T segments. The 48-hour ambulatory ECG depicted normal sinus rhythm with intermittent short PR interval without tachyarrhythmias. The chest Xray revealed cardiomegaly without pulmonary venous congestion. Although serial transthoracic echocardiographic examination demonstrated pericardial effusion with features of tamponade, there were no overt signs of clinical cardiac tamponade. Biochemically, the serum thyroxine of 3 pmol/l (normal 10 to 25) and thyroid-stimulating hormone of 160 mU/l (normal 0.20 to 4.20)) were compatible with hypothyroidism. The patient was treated with L-thyroxine sodium daily, which was gradually increased to 0.125 mg daily. Within a few months he lost weight and became more alert; furthermore, the symptoms of hypothyroidism and the pericardial effusion resolved. It can be concluded that Down syndrome may be associated with hypothyroidism and pericardial effusion. These were alleviated following hormone replacement. Regular evaluation of thyroid function tests is important in Down syndrome. (Neth Heart J 2007;15:67-70.).

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“…However, absence of the low QRS voltage does not rule out the tamponade. In some patients (e.g., 3/25 [12%] in the study of Oliver et al [13]), the voltage remained low after pericardiocentesis. However, QRS voltage also recovered after successful anti-inflammatory treatment, without pericardiocentesis.…”

Section: Diagnostic Approach To Cardiac Tamponadementioning

confidence: 97%

Management Strategies in Pericardial Emergencies

Seferović

Ristić

Imazio

et al. 2006

Herz

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Natural history of pericardial diseases can be complicated with pericardial emergencies requiring prompt diagnosis, intensive care with hemodynamic monitoring, and early aggressive management. Medical supportive measures, drainage of pericardial effusion, surgical pericardiotomy, and pericardiectomy should be applied when needed with no delay. This procedural approach also applies to iatrogenic interventions leading to tamponade.

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Low QRS voltage in cardiac tamponade: a study of 70 cases

Cited by 13 publications

References 6 publications

The Electrocardiogram in Large Pericardial Effusion: The Forgotten “P” Wave and the Influence of Tamponade, Size, Etiology, and Pericardial Thickness on QRS Voltage

The Electrocardiogram in Large Pericardial Effusion: The Forgotten “P” Wave and the Influence of Tamponade, Size, Etiology, and Pericardial Thickness on QRS Voltage

Down syndrome associated with hypothyroidism and chronic pericardial effusion: echocardiographic follow-up

Management Strategies in Pericardial Emergencies

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