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Recognizing the Link Between Peripheral Edema and Voltage Attenuation of QRS Complexes : Implications for the Critical Care Patient

John E. Madias
Author and Funding Information

Affiliations: Elmhurst, NY
 ,  Dr. Madias is Professor of Medicine (Cardiology), Division of Cardiology, Elmhurst Hospital Center.

Correspondence to: John E. Madias, MD, Professor of Medicine (Cardiology), Division of Cardiology, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY 11373; e-mail: madiasj@nychhc.org



Chest. 2003;124(6):2041-2044. doi:10.1378/chest.124.6.2041
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Extract

Browsing of serial ECGs obtained in patients with anasarca peripheral edema (AN) in the coronary care unit, respiratory care unit, surgical ICU, other critical care units, and the general medical wards will convince physicians about the ubiquitous presence of examples of patients showing gradual attenuation of the voltage of QRS complexes. Furthermore, such dynamic reduction of the amplitude of QRS complexes will become apparent in patients who merely have gained weight without revealing overwhelming signs of peripheral fluid sequestration. Also what immediately becomes obvious is the large range of pathologic conditions present in patients with this association of AN and reduced QRS potentials; thus, instead of mainly encountering patients with cardiac illnesses, the patients with this ECG syndrome have chronic or acute renal failure, sepsis, or for whatever reasons have received large amounts of IV fluids. A corollary of this is that the pathophysiology involved is not heart-based, but rather of some uniform extracardiac origin.1

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