Pericardial effusionCreated OnApril 20, 2020Last Updated OnOctober 28, 2020byadmin You are here: Main ECG Pericardial effusion < All Topics Table of Contents Classic findings in pericardial effusion Electrical alternans Present in <30% of patients Tachycardia May be blunted in patients taking cardiac medications Low voltage Cardiomegaly in CXR Sensitive but not specific New low voltage ECG + Tachycardia = Pericardial effusion until proven otherwise! Low Voltage Definition Sensitive Definition QRS amplitudes in leads I+II+III < 15 mm Or QRS amplitudes in leads V1+V2+V3 < 30 mm Specific Definition QRS amplitudes in limb leads all < 5 mm Or QRS amplitude in all precordial leads < 10 mm Take home Points Pulmonary embolism and large pericardial effusions can often present similarly! Both have similar patient risk factors Both may present with: dyspnoea, tachypnoea, tachycardia, JVD, and hypotension when severe Don’t forget about pericardial effusion in the differential diagnosis for patients with dyspnoea and clear lungs! (Large) Pericardial effusion triad is not always present Low voltage (best to compare to prior ECGs) Tachycardia (medications may blunt a tachycardic response) Electrical alternans (present in < 1/3 of cases) When in doubt…do the bedside echo looking for an effusion! *We do not own this ECG, it’s for knowledge sharing purpose
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