Clinical Notes : Cardiology

118. ECG - Pericardial Effusion

ECG - Pericardial Effusion

Features

  • Initially the ECG feature are those of Pericarditis

 
  • Later, the ECG feature of massive pericarial effusion are :

    • Low QRS voltage

    • Tachycardia

    • Electrical alternans

 

Massive Pericardial Effusion

 

Low QRS Voltage

  • Low voltage is produced by…

    • The “damping” effect of increased layers of fluid, fat or air between the heart and the recording electrode.

    • Loss of viable myocardium.

    • Diffuse infiltration or myxoedematous involvement of the heart.

  • Other causes of low voltage include:

    • Fluid

      • ​Pleural effusion

    • Fat

      • Obesity

    • Air

      • Emphysema

      • Pneumothorax

    • Infiltrative / Connective Tissue Disorders

      • Myxoedema

      • Infiltrative myocardial diseases — i.e. restrictive cardiomyopathy due to amyloidosis, sarcoidosis, haemochromatosis

      • Constrictive pericarditis

      • Scleroderma

    • Loss of viable myocardium

      • Previous massive MI

      • End-stage dilated cardiomyopathy

 

Electrical Alternans

  • consecutive, normally-conducted QRS complexes alternate in height

  • the heart swings backwards and forwards within a large fluid-filled pericardium

Management

Refer A+E

 
 
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