Journal of Cardiac Failure
Volume 14, Issue 1 , Pages 55-60 , February 2008

The Importance of the P-Waves in the Differentiation of Attenuation of the QRS Voltage Due to Pericardial Effusion Versus Due to Peripheral Edema

  • John E. Madias, MD, FACC, FAHA

      Affiliations

    • Corresponding Author InformationReprint requests: John E. Madias, MD, FACC, FAHA, Professor of Medicine (Cardiology), Division of Cardiology, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY 11373.

Received 15 June 2006 ,Revised 27 June 2007 ,Accepted 1 August 2007.

References 

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  2. Spodick DH. Pericardial diseases. In:  Braunwald E,  Zipes DP,  Libby P editor. Heart Disease, ed 6. Philadelphia: WB Saunders Company; 2001;p. 1823–1829
  3. Meyers DG, Bagin RG, Levene JF. Electrocardiographic changes in pericardial effusion. Chest. 1993;104:1422–1426
  4. Eisenberg MJ, de Romeral LM, Heidenreich PA, et al. The diagnosis of pericardial effusion and cardiac tamponade by 12-lead ECG. A technology assessment. Chest. 1996;110:318–324
  5. Kudo Y, Yamasaki F, Doi T, et al. Clinical significance of low voltage in asymptomatic patients with pericardial effusion free of heart disease. Chest. 2003;124:2064–2067
  6. Spodick DH. Low voltage with pericardial effusion: complexity of mechanisms. Chest. 2003;124:2044–2045
  7. Karatay CM, Fruehan CT, Lighty GW, et al. Acute pericardial distension in pigs: effect of fluid conductance on body surface electrocardiogram QRS size. Cardiovasc Res. 1993;27:1033–1038
  8. Bruch C, 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. 2001;38:219–226
  9. Brody DA. A theoretical analysis of intracavitary blood mass influence on heart lead relationship. Circ Res. 1956;4:731
  10. Madias JE, Bazaz R, Agarwal H, et al. Anasarca mediated attenuation of the amplitude of electrocardiogram complexes. A description of a heretofore unrecognized phenomenon. J Am Coll Cardiol. 2001;38:756–764
  11. Madias JE. P-waves in patients with changing edematous states: implications on interpreting repeat P-wave measurements in patients developing anasarca or undergoing hemodialysis. Pacing Clin Electrophysiol. 2004;27:749–756
  12. Feigenbaum H. Echocardiography, ed 5. Philadelphia: Lea & Febiger; 1994;p. 558–60
  13. Madias JE, Agarwal H, Win M, et al. Effects of weight loss in congestive heart failure from idiopathic dilated cardiomyopathy on electrocardiographic QRS voltage. Am J Cardiol. 2002;89:86–88
  14. Madias JE, Attanti S, Narayan V. Relationship among electrocardiographic potential amplitude, weight, and resistance/reactance/impedance in a patient with peripheral edema treated for congestive heart failure. J Electrocardiol. 2003;36:167–171
  15. Madias JE, Song J, White CM, et al. Response of the ECG to short-term diuresis in patients with heart failure. Ann Noninvasive Electrocardiol. 2005;10:288–296
  16. Ishikawa K, Berson AS, Pipberger HV. Electrocardiographic changes due to cardiac enlargement. Am Heart J. 1971;81:635–643
  17. Madias JE. Standard electrocardiographic and signal-averaged electrocardiographic changes in congestive heart failure. Congest Heart Fail. 2005;11:266–271
  18. Madias JE. ECG changes in response to diuresis in an ambulatory patient with congestive heart failure. Congest Heart Fail. 2006;12:277–283
  19. Ishikawa K, Nagasawa T, Shimada H. Influence of hemodialysis on electrocardiographic wave forms. Am Heart J. 1979;97:5–11
  20. Madias JE. Peripheral edema masks the diagnoses of P-pulmonale, P-mitrale, and biatrial abnormality: clinical implications for patients with heart failure. Congest Heart Fail. 2006;12:20–24
  21. Fuenmayor AJ, Vasquez CJ, Fuenmayor AM, et al. Hemodialysis changes the QRS amplitude in the electrocardiogram. Int J Cardiol. 1993;41:141–145
  22. Ojanen S, Koobi T, Korhonen P, et al. QRS amplitude and volume changes during hemodialysis. Am J Nephrol. 1999;19:423–427
  23. Madias JE. Reversible attenuation of voltage of QRS complexes and P-waves and shortening of QRS duration and QTc interval consequent to large perioperative intravenous fluid infusions. J Electrocardiol. 2006;39:415–418
  24. Madias JE, Narayan V, Attari M. Detection of P-waves via a “saline-filled central venous catheter ECG lead” in patients with low ECG voltage due to anasarca. Am J Cardiol. 2003;91:910–914
  25. Gettes LA, Baker LE. The specific resistance of biological materials—a compendium of data for the biomedical engineer and physiologist. Med Biol Eng. 1967;5:271–293

PII: S1071-9164(07)01025-1

doi: 10.1016/j.cardfail.2007.08.004

Journal of Cardiac Failure
Volume 14, Issue 1 , Pages 55-60 , February 2008

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