UMEM Educational Pearls

Category: Cardiology

Title: low QRS voltage on the ECG

Keywords: low voltage, electrocardiography (PubMed Search)

Posted: 11/9/2008 by Amal Mattu, MD (Updated: 8/17/2022)
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Low QRS voltage (LV) on the ECG is generally defined as the presence of QRS amplitudes which are < 0.5 mV (5 mm) in all of the limb leads and < 1.0 mV (10 mm) in all of the precordial leads. This is a fairly tight definition and for practical purposes, the definition is sometimes expanded to include patients with the sum of QRS amplitudes in leads I, III, and III adding up to < 15 mm; OR the sum of the QRS amplitudes in leads V1, V2, and V3 adding up to < 30 mm. Causes of LV can be divided into two major groups: (1) deficiency of the heart's generated potentials, or "cardiac causes," and (2) attenuating influences outside the heart, or "extracardiac causes." Cardiac causes include: cardiomyopathies (which can sometimes be caused by multiple prior MIs), infiltrative cardiac diseases (e.g. amyloid), severe hypothermia, and inflammatory diseases of the heart due to chemicals or infections (incl. myocarditis). Extracardiac causes include: large pericardial or pleural effusions, obesity, COPD (esp. if a barrel chest is present), pneumothorax and other forms of barotrauma (esp. left-sided).