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

Abstract

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.

Get full access to this article

View all access options for this article.

References

Meyers DG , Bagin RG : Electrocardiographic changes in pericardial effusion. Chest 104:422-426, 1993.

Eisenberg MJ , de Romeral LM , Heidenreich PA , et al : The diagnosis of pericardial effusion and cardiac tamponade by 12 lead ECG. Chest 110:318-324, 1996.

Bruch G , Schmermund A , Dagres N , et al : Changes in QRS voltage in cardiac tamponade and pericardial effusion: Reversibility after pericardiocentesis and after anti-inflammatory drug treatment. J Am Coll Cardiol 38:219-226, 2001.

Smedema JP , Katjitae I , Reuter H , et al : Twelve-lead electrocardiography in tuberculous pericarditis. Cardiovasc J S Afr 12:31-34, 2001.

Oliver C , Marin F , Pineda J , et al : Low QRS voltage in cardiac tamponade: A study of 70 cases. Int J Cardiol 83:91-92, 2002.

Appleton CP , Hatle LK , Popp RL : Cardiac tamponade and pericardial effusion: Respiratory variation in transvalvular flow velocities studied by Doppler echocardiography. J Am Coll Cardiol 11:1020-1030, 1988.

Wagner GS : Marriott’s Practical Electrocardiography. Philadelphia: Lippincott Williams and Wilkins, 2001, p 48.

Endrys J , Simo M , Shafie MZ , et al : New nonsurgical technique for multiple pericardial biopsies. Cathet Cardiovasc Diagn 15:92-94, 1988.

Hoit BD : Diseases of the pericardium. In: Hurst’s The Heart, ed. by Fuster V , Alexander RW , O’Rourke RA. New York: McGraw-Hill, 2001, p 2077.

10.

Chou TC : Electrocardiography in Clinical Practice. Adult and Pediatric. Philadelphia: WB Saunders Co, 1996, p 240.

11.

Hoit BD : Diseases of the pericardium. In: Hurst’s The Heart, ed. by Fuster V , Alexander RW , O’Rourke RA. New York: McGraw-Hill, 2001, p 2073.

12.

Toney JC , Kolmen SN : Cardiac tamponade: Fluid and pressure effects on electrocardiographic changes. Proc Soc Biol Med 12:42-48, 1966.

13.

Karatay CM , Fruehan CT , Lighty GW Jr , et al : Acute epicardial distension in pigs: Effect of fluid conductance on body surface electrocardiogram QRS size. Cardiovasc Res 27:1033-1038, 1993.

14.

Brody DA : A theoretical analysis of intracavitary blood mass influence on the heart-lead relationship. Circ Res 4:731-738, 1956.