LETTER TO THE EDITOR
Anasarca and low electrocardiogram voltage
F. James Brennan, MD, FACC*
* Kingston General Hospital, 76 Stuart St., Kingston, ON K7L 2V7,Canada
brennanj{at}kgh.kari.net
In a recent article in the Journal, Madias et al. (1) reported an inverse relationship between electrocardiogram (ECG) voltage and changes in body weight due to fluid loss or retention in patients with anasarca. The investigators could find no reference in the literature to a link between low ECG voltage and anasarca. A direct correlation has been reported, however, between ECG voltage and the concentration of serum albumin (2). Anasarca is frequently associated with a lowered serum albumin concentration (3). To ascertain how much the Madias et al. (1) study expands existing knowledge, it would be necessary to correlate the observed changes in ECG voltage with concomitant changes in serum albumin. Are the investigators able to do this?
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References
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1. Madias JE, Bazaz R, Agarwal H, Win M, Medepalli L. Anasarca-mediated attenuation of the amplitude of electrocardiogram complexes: a description of a heretofore unrecognized phenomenon. J Am Coll Cardiol. 2001;38:756–764[Abstract/Free Full Text]
2. Heaf JG. Albumin-induced changes in the electrocardiographic QRS complex. Am J Cardiol. 1985;55:1530–1533[CrossRef][Medline]
3. Braunwald E. Edema. Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL. Harrison’s Principles of Internal Medicine. 15th ed. New York, NY: McGraw-Hill; 2001. p. 217–222
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