Low QRS voltage

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: low volts; low voltage; low QRS; reduced voltage; Reduced QRS voltage; low voltage QRS complexes; diminished QRS; diminished QRS voltage; diminished voltage; Low amplitude QRS complexes; low voltage on the EKG; low volts

Overview

Low QRS voltage is a non-specific electrocardiographic finding in which the voltage (the height) of the QRS complexes is reduced.

Definitions of Low QRS Voltage:

  • If the total amplitude above and below the isoelectric line is < 5 mm in all 3 standard leads.
  • An average voltage in the limb leads of < 5 mm with an average of < 10 mm in the chest leads.
  • Should be at least 5 mm in V1 and V6 , 7 mm in V2 and V5 and 9 mm in V3 and V4.

Pathophysiology of Low QRS Voltage

Low voltage on the ECG tracing generally comes from either Low Power within the myocardium or Low Conduction from the heart to the ECG leads. There are three general processes that contribute to low QRS voltage:

  1. Damping of the electrical signal due to excess air (emphysema, COPD), fluid (pericardial effusion, pericardial constriction, pleural effusion), edema (anasarca), fat (obesity), or amyloid cardiomyopathy
  2. Electrically inert myocardium due to a loss of viable myocardium such as in myocardial infarction and Chagas disease]]
  3. Infiltration of the myocardium (myxedematous, Chagas disease)

Causes of Low QRS Voltage

The presence of low voltage on the EKG should prompt an evaluation to rule out life threatening emergencies such as cardiac tamponade or a large pericardial effusion. These two diagnoses are suggested by the presence of tachycardia and electrical alternans along with the low QRS voltage. In alphabetical order the differential diagnosis includes[1]:

Electrocardiographic Examples

References

  1. Madias JE. Low QRS voltage and its causes. J Electrocardiol. 41 (6): 498-500. doi:10.1016/j.jelectrocard.2008.06.021 - Pubmed citation
  2. 2.0 2.1 Madias JE (2008). "Low QRS voltage and its causes". J Electrocardiol. 41 (6): 498–500. doi:10.1016/j.jelectrocard.2008.06.021. PMID 18804788.
  3. Chinitz JS, Cooper JM, Verdino RJ (2008). "Electrocardiogram voltage discordance: interpretation of low QRS voltage only in the limb leads". J Electrocardiol. 41 (4): 281–6. doi:10.1016/j.jelectrocard.2007.12.001. PMID 18353352.
  4. http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&ved=0CCYQFjAA&url=http%3A%2F%2Fwww.medschool.lsuhsc.edu%2Femergency_medicine%2Fdocs%2FTop%2520Ten%2520(or%252011)%2520EKG%2520Killers.ppt&ei=PXJeUJ0xp9rRAbOOgagK&usg=AFQjCNGGRSrJfRVl3cMy5au0lnmpeaBRQA