The Diagnosis of Pericardial Effusion and Cardiac Tamponade by 12-Lead ECG

Eisenberg, Mark J.; Romeral, Luisa Munoz De; Heidenreich, Paul A.; Schiller, Nelson B.; Evans, Griffith

doi:10.1378/chest.110.2.318

Cited by 77 publications

(49 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Common cardiovascular signs of hypothyroidism include bradycardia, diastolic hypertension, narrowed pulse pressure, pericardial effusion (PE) and low voltage of the surface electrocardiogram (ECG) [1,2,3,4,5]. Echocardiography demonstrates small or moderate PE in up to one third of hypothyroid patients [1,2,3,4,5], but low voltage is not specific or sensitive enough to diagnose the presence of PE [2,6,7,8,9]. In our earlier study, we found that even a small PE associated with malignancy or a connective tissue disease caused low voltage on the surface ECG [9].…”

Section: Introductionmentioning

confidence: 99%

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

Yamanaka¹,

Kumon²,

Matsumura

et al. 2010

Cardiology

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

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

Yamanaka¹,

Kumon²,

Matsumura

et al. 2010

Cardiology

View full text Add to dashboard Cite

show abstract

“…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.…”

Section: Introductionmentioning

confidence: 99%

Precordial low voltage in patients with ascites

et al. 2007

View full text Add to dashboard Cite

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.

show abstract

“…This diagnosis is suggested by positive cardiac biomarkers and evidence of regional or global left ventricular dysfunction. Myopericarditis should be suspected in cases with arrhythmias, recent febrile illness, and is more common in both younger and male patients [14]. Unlike uncomplicated AP, patients with myopericarditis warrant hospital admission to rule out other causes and for arrhythmia monitoring.…”

Section: Treatmentmentioning

confidence: 99%

Pericarditis and Pericardial Effusion: Management Update

Sparano

Ward

2011

Curr Treat Options Cardio Med

View full text Add to dashboard Cite

Prompt recognition of the signs and symptoms of pericardial disease is critical so that appropriate treatments can be initiated. Acute pericarditis has a classical presentation, including symptoms, physical examination findings, and electrocardiography abnormalities. Early recognition of acute pericarditis will avoid unnecessary invasive testing and prompt therapies that provide rapid symptom relief. Non-steroidal anti-inflammatory drugs (NSAIDs) remain first-line therapy for uncomplicated acute pericarditis, although colchicine can be used concomitantly with NSAIDS as the first-line approach, particularly in severely symptomatic cases. Colchicine should be used in all refractory cases and as initial therapy in all recurrences. Aspirin should replace NSAIDS in pericarditis complicating acute myocardial infarction. Systemic corticosteroids can be used in refractory cases or in those with immune-mediated etiologies, although generally should be avoided due to a higher risk of recurrence. Pericardial effusions have many etiologies and the approach to diagnosis and therapy depends on clinical presentation. Pericardial tamponade is a life-threatening clinical diagnosis made on physical examination and supported by characteristic findings on diagnostic testing. Prompt diagnosis and management is critical. Treatment consists of urgent pericardial fluid drainage with a pericardial drain left in place for several days to help prevent acute recurrence. Analysis of pericardial fluid should be performed in all cases as it may provide clues to etiology. Consultation of cardiac surgery for pericardial window should be considered in recurrent cases and may be the first-line approach to malignant effusions, although acute relief of hemodynamic compromise must not be delayed. Constrictive pericarditis is associated with symptoms that mimic many other cardiac conditions. Thus, correct diagnosis is critical and involves identification of pericardial thickening or calcification in association with characteristic hemodynamic alterations using noninvasive and invasive diagnostic approaches. Constrictive physiology may occur transiently and resolve with medical therapy. In chronic cases, definitive therapy requires referral to an experienced surgeon for pericardiectomy.

show abstract

The Diagnosis of Pericardial Effusion and Cardiac Tamponade by 12-Lead ECG

Cited by 77 publications

References 19 publications

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

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

Precordial low voltage in patients with ascites

Pericarditis and Pericardial Effusion: Management Update

Contact Info

Product

Resources

About