Absolute Small Voltage in Anasarca

Report:

S tachycardia 111/min

Absolute small voltage

Poor R wave progression

Comment:

While frontal leads’ small voltage is too common to have great clinical significance, absolute small voltage is always pathological. Curiously, students almost invariably mention emphysema, pericardial disease, myocardial infiltration, morbid obesity and myxœdema before its commonest cause, multiple or extensive myocardial infarctions7. This last is unlikely here, despite the poor R wave progression: the R/S ratio increases from right to left in the chest leads and there are no pathological Q waves or repolarisation abnormalities.

In the context of massive œdema, effusions and ascites one need not look further. Even in known CCF, the voltage attenuation seen is due to extracardiac factors and improves in response to successful therapy8.

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