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;

Overview

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

Three general processes 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), physiologic variant, 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

Low voltage QRS <10mm precordial

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