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

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background: The cases of the 3 patients reported herein show the role of the P-waves in the differential diagnosis of the attenuated voltage of QRS complexes from pericardial effusion (PEREF) and from those resulting from peripheral edema (PERED) of varying pathophysiologic etiology. Methods and Results: Whereas the QRS complexes decrease similarly in these 2 conditions, the voltage of P-waves do not become attenuated in PEREF, but do so in PERED. The underlying mechanism preventing attenuation of the voltage of P-waves in PEREF is the lack of much fluid around the atria, particularly in the presence of less than massive PEREF (no local electrical short-circuiting influence), in contrast to the attenuating effect exerted to both ventricles and atria in patients with PERED, who as a result, show parallel decrease in the voltage of QRS complexes and P-waves. Conclusion: Attenuation of the amplitude of the electrocardiogram QRS complexes occurs in both patients with PEREF and PERED; however, attenuation of the amplitude of the P-waves is seen only in patients with PERED, and this observation is useful in the differential diagnosis of these 2 clinical conditions.

Original languageEnglish
Pages (from-to)55-60
Number of pages6
JournalJournal of Cardiac Failure
Volume14
Issue number1
DOIs
StatePublished - Feb 2008
Externally publishedYes

Keywords

  • ECG
  • Pericardial effusion
  • congestive heart failure
  • electrophysiology
  • peripheral edema

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