Small Voltage in Anasarca
Report:
Sinus rhythm 98/min
Absolute small voltage
Diffuse nonspecific ST/T changes
Prolonged QT interval
Comment:
The entire QRS complex is less than 5 mm in the frontal leads and less than 8 mm in the precordial leads. The commonest cause is extensive or multiple myocardial infarction; others include pericardial disease (not necessarily with effusion), myxœdema (with or without effusion), emphysema and anasarca.
Diffuse T wave changes and prolonged QTc would favour hypothyroidism here, but the rate is somewhat against it. It should be noted, however, that bradycardia is not a prerequisite for that diagnosis, even for myxœdema coma.
The cause for the prolonged QT interval remained unknown in this patient. Again, myxœdema is an attractive possibility, but she did not have it.
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