Baylor University Medical Center Proceedings April 2017 - 229

a

b

c

d

Figure 2. Transthoracic echocardiographic views-(a) parasternal short-axis view, (b) short-axis parasagittal view, and (c) apical four-chamber view-showing a
brightly echogenic myocardium, thickened right ventricular and left ventricular walls, thickened valve leaflets, dilated right atrium, dilated left atrium, and a pericardial
effusion. (d) A "bulls-eye" map of peak systolic longitudinal strain showing the characteristic "cherry-on-top" pattern of myocardial amyloidosis with preserved strain
at the apex (dark red center) and abnormal strain elsewhere (pink or blue).

total QRS voltage has rarely been employed as an indicator of
low QRS voltage. Among the 10 conditions in which total QRS
voltage was measured and reported, those with the lowest voltage
included cardiac amyloidosis, 58-199 mm (mean 104); cardiac
adiposity, 73-210 mm (mean 120); and the carcinoid syndrome,
48-227 mm (mean 117). The lowest total 12-lead QRS voltage
among the previously described 331 patients was 58 mm. Thus,
to have an electrocardiographic total 12-lead QRS voltage of only
34 mm, as in the present patient, is indeed unusual.
A limitation of the present report is the lack of anatomic
confirmation of cardiac amyloidosis. The echocardiogram, however, is virtually diagnostic of extensive cardiac amyloidosis.
1.

2.

Figure 3. Various QRS complexes showing how each was measured. Reproduced
from Siegel and Roberts (1) with permission of the authors and the publisher.
April 2017

Siegel RJ, Roberts WC. Electrocardiographic observations in severe aortic
valve stenosis: correlative necropsy study to clinical, hemodynamic, and
ECG variables demonstrating relation of 12-lead QRS amplitude to peak
systolic transaortic pressure gradient. Am Heart J 1982;103(2):210-221.
Roberts WC, Filardo G, Ko JM, Siegel RJ, Dollar AL, Ross EM, Shirani J. Comparison of total 12-lead QRS voltage in a variety of cardiac conditions and its usefulness in predicting increased cardiac mass. Am J Cardiol 2013;112(6):904-909.

Two causes in one patient for extremely low voltage on the electrocardiogram

229



Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings April 2017

No label
Baylor University Medical Center Proceedings April 2017 - No label
Baylor University Medical Center Proceedings April 2017 - Cover2
Baylor University Medical Center Proceedings April 2017 - 137
Baylor University Medical Center Proceedings April 2017 - 138
Baylor University Medical Center Proceedings April 2017 - 139
Baylor University Medical Center Proceedings April 2017 - 140
Baylor University Medical Center Proceedings April 2017 - 141
Baylor University Medical Center Proceedings April 2017 - 142
Baylor University Medical Center Proceedings April 2017 - 143
Baylor University Medical Center Proceedings April 2017 - 144
Baylor University Medical Center Proceedings April 2017 - 145
Baylor University Medical Center Proceedings April 2017 - 146
Baylor University Medical Center Proceedings April 2017 - 147
Baylor University Medical Center Proceedings April 2017 - 148
Baylor University Medical Center Proceedings April 2017 - 149
Baylor University Medical Center Proceedings April 2017 - 150
Baylor University Medical Center Proceedings April 2017 - 151
Baylor University Medical Center Proceedings April 2017 - 152
Baylor University Medical Center Proceedings April 2017 - 153
Baylor University Medical Center Proceedings April 2017 - 154
Baylor University Medical Center Proceedings April 2017 - 155
Baylor University Medical Center Proceedings April 2017 - 156
Baylor University Medical Center Proceedings April 2017 - 157
Baylor University Medical Center Proceedings April 2017 - 158
Baylor University Medical Center Proceedings April 2017 - 159
Baylor University Medical Center Proceedings April 2017 - 160
Baylor University Medical Center Proceedings April 2017 - 161
Baylor University Medical Center Proceedings April 2017 - 162
Baylor University Medical Center Proceedings April 2017 - 163
Baylor University Medical Center Proceedings April 2017 - 164
Baylor University Medical Center Proceedings April 2017 - 165
Baylor University Medical Center Proceedings April 2017 - 166
Baylor University Medical Center Proceedings April 2017 - 167
Baylor University Medical Center Proceedings April 2017 - 168
Baylor University Medical Center Proceedings April 2017 - 169
Baylor University Medical Center Proceedings April 2017 - 170
Baylor University Medical Center Proceedings April 2017 - 171
Baylor University Medical Center Proceedings April 2017 - 172
Baylor University Medical Center Proceedings April 2017 - 173
Baylor University Medical Center Proceedings April 2017 - 174
Baylor University Medical Center Proceedings April 2017 - 175
Baylor University Medical Center Proceedings April 2017 - 176
Baylor University Medical Center Proceedings April 2017 - 177
Baylor University Medical Center Proceedings April 2017 - 178
Baylor University Medical Center Proceedings April 2017 - 179
Baylor University Medical Center Proceedings April 2017 - 180
Baylor University Medical Center Proceedings April 2017 - 181
Baylor University Medical Center Proceedings April 2017 - 182
Baylor University Medical Center Proceedings April 2017 - 183
Baylor University Medical Center Proceedings April 2017 - 184
Baylor University Medical Center Proceedings April 2017 - 185
Baylor University Medical Center Proceedings April 2017 - 186
Baylor University Medical Center Proceedings April 2017 - 187
Baylor University Medical Center Proceedings April 2017 - 188
Baylor University Medical Center Proceedings April 2017 - 189
Baylor University Medical Center Proceedings April 2017 - 190
Baylor University Medical Center Proceedings April 2017 - 191
Baylor University Medical Center Proceedings April 2017 - 192
Baylor University Medical Center Proceedings April 2017 - 193
Baylor University Medical Center Proceedings April 2017 - 194
Baylor University Medical Center Proceedings April 2017 - 195
Baylor University Medical Center Proceedings April 2017 - 196
Baylor University Medical Center Proceedings April 2017 - 197
Baylor University Medical Center Proceedings April 2017 - 198
Baylor University Medical Center Proceedings April 2017 - 199
Baylor University Medical Center Proceedings April 2017 - 200
Baylor University Medical Center Proceedings April 2017 - 201
Baylor University Medical Center Proceedings April 2017 - 202
Baylor University Medical Center Proceedings April 2017 - 203
Baylor University Medical Center Proceedings April 2017 - 204
Baylor University Medical Center Proceedings April 2017 - 205
Baylor University Medical Center Proceedings April 2017 - 206
Baylor University Medical Center Proceedings April 2017 - 207
Baylor University Medical Center Proceedings April 2017 - 208
Baylor University Medical Center Proceedings April 2017 - 209
Baylor University Medical Center Proceedings April 2017 - 210
Baylor University Medical Center Proceedings April 2017 - 211
Baylor University Medical Center Proceedings April 2017 - 212
Baylor University Medical Center Proceedings April 2017 - 213
Baylor University Medical Center Proceedings April 2017 - 214
Baylor University Medical Center Proceedings April 2017 - 215
Baylor University Medical Center Proceedings April 2017 - 216
Baylor University Medical Center Proceedings April 2017 - 217
Baylor University Medical Center Proceedings April 2017 - 218
Baylor University Medical Center Proceedings April 2017 - 219
Baylor University Medical Center Proceedings April 2017 - 220
Baylor University Medical Center Proceedings April 2017 - 221
Baylor University Medical Center Proceedings April 2017 - 222
Baylor University Medical Center Proceedings April 2017 - 223
Baylor University Medical Center Proceedings April 2017 - 224
Baylor University Medical Center Proceedings April 2017 - 225
Baylor University Medical Center Proceedings April 2017 - 226
Baylor University Medical Center Proceedings April 2017 - 227
Baylor University Medical Center Proceedings April 2017 - 228
Baylor University Medical Center Proceedings April 2017 - 229
Baylor University Medical Center Proceedings April 2017 - 230
Baylor University Medical Center Proceedings April 2017 - 231
Baylor University Medical Center Proceedings April 2017 - 232
Baylor University Medical Center Proceedings April 2017 - 233
Baylor University Medical Center Proceedings April 2017 - 234
Baylor University Medical Center Proceedings April 2017 - 235
Baylor University Medical Center Proceedings April 2017 - 236
Baylor University Medical Center Proceedings April 2017 - 237
Baylor University Medical Center Proceedings April 2017 - 238
Baylor University Medical Center Proceedings April 2017 - 239
Baylor University Medical Center Proceedings April 2017 - 240
Baylor University Medical Center Proceedings April 2017 - 241
Baylor University Medical Center Proceedings April 2017 - 242
Baylor University Medical Center Proceedings April 2017 - 243
Baylor University Medical Center Proceedings April 2017 - 244
Baylor University Medical Center Proceedings April 2017 - 245
Baylor University Medical Center Proceedings April 2017 - 246
Baylor University Medical Center Proceedings April 2017 - 247
Baylor University Medical Center Proceedings April 2017 - 248
Baylor University Medical Center Proceedings April 2017 - 249
Baylor University Medical Center Proceedings April 2017 - 250
Baylor University Medical Center Proceedings April 2017 - 251
Baylor University Medical Center Proceedings April 2017 - 252
Baylor University Medical Center Proceedings April 2017 - Cover3
Baylor University Medical Center Proceedings April 2017 - Cover4
http://www.brightcopy.net/allen/bapr/30-4
http://www.brightcopy.net/allen/bapr/30-3
http://www.brightcopy.net/allen/bapr/30-2
http://www.brightcopy.net/allen/bapr/30-1
http://www.brightcopy.net/allen/bapr/29-4
http://www.brightcopy.net/allen/bapr/29-3
http://www.brightcopy.net/allen/bapr/29-2
http://www.brightcopy.net/allen/bapr/29-1
http://www.brightcopy.net/allen/bapr/28-04
https://www.nxtbook.com/allen/bapr/28-3
https://www.nxtbook.com/allen/bapr/28-2
https://www.nxtbook.com/allen/bapr/28-1
https://www.nxtbook.com/allen/bapr/27-4
https://www.nxtbook.com/allen/bapr/27-3
https://www.nxtbookmedia.com