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Anasarca-mediated attenuation of the amplitude of electrocardiogram complexes: a description of a heretofore unrecognized phenomenon

^a Zena and Michael Wiener Cardiovascular Institute, Mount Sinai/New York University Medical Center Health System, New York, New York, USA
^b Division of Cardiology, Elmhurst Hospital Center, Mount Sinai School of Medicine, New York, New York, USA

View larger version (83K): [in a new window]   Figure 1 Electrocardiograms on the designated days of hospitalization revealing the decrease (A and B) and subsequent increase (B and C) in the amplitude of QRS complexes. QRS = sum of the amplitudes of QRS complexes.

View larger version (35K): [in a new window]   Figure 2 Gradual reduction in the QRS potentials was observed in this patient (Pt) with left bundle branch block. wt. = weight in between admission and peak weights; wt. = weight.

View larger version (32K): [in a new window]   Figure 3 Serial weights and corresponding sum of the amplitudes of QRS complexes (QRS) revealing the reciprocal relation of these two variables in this patient (Pt).

View larger version (21K): [in a new window]   Figure 4 Points 1 to 3 of the plot for each patient (Pt) represent the one-half, the peak and the subsequent lowest weights, correspondingly. Variables are adjusted to admission values. QRS = sum of the amplitudes of QRS complexes; wt. = weight; % = percent change.

View larger version (57K): [in a new window]   Figure 5 Marked attenuation of QRS potentials was noted in this patient (Pt). The echocardiogram (2D-Echo) did not reveal a pericardial effusion. Ao = aorta; A4-Ch = apical four-chamber view; LA = left atrium; LV = left ventricle; PLAx = parasternal long-axis view; RA = right atrium; RV = right ventricle; T = thrombus.

View larger version (41K): [in a new window]   Figure 6 Attenuation of QRS potentials was noted in this patient (Pt) before (day 21) continuous venovenous hemofiltration carried out for seven days, with marked recovery of the potentials, paralleling the loss of weight (day 28). Meanwhile, the intracardiac electrocardiograms (IC-ECGs) did not change. The echocardiogram (2D-Echo) revealed a barely perceptible pericardial effusion (day 20). A4-Ch = apical four-chamber view; LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle.