Absolute Small Voltage & Its Commonest Cause

Report:

Sinus rhythm 77/min

Absolute small voltage

Anterior infarction, age indeterminate

Comment:

This patient, too, had history of a remote infarction; like the previous case, he too could have a ventricular aneurysm. He was asymptomatic and there was no need to perform angiography or any other test to define the putative aneurysm by its dyskinesia, paradoxical expansion, etc. He is here to exemplify the commonest cause of small voltage (QRS < 5mm in frontal, < 10mm in chest leads): multiple or large infarcts.

Small voltage confined to the frontal leads does not have great (or any) clinical significance; absolute small voltage does. In patients with heart failure it is a marker of disease severity and adverse outcome at 1 year80. 111. 68 year old man with hyperlipidæmia, hypertension and positive stress test returning to CCU following PTCA to LAD and LCX arteries. Severe chest pain developed on arrival (Fig 111a). What is the likely cause?

111a. The ECG electrodes from Fig 111 were still attached when this recording was taken.