Electrocardiogram voltage attenuation and shortening of the duration of P-waves, QRS complexes, and QT intervals

Multiple pathologies in concert may lead to attenuation of the electrocardiogram (ECG) voltage. A case of a patient illustrating the above is presented, who showed marked attenuation of the ECG voltage. Automated values of the amplitude of the ECG QRS complexes, P-waves, and T-waves (in mm), duration of the QRS complexes, P-waves, and QT intervals (in ms), in 2 ECGs were compared. The patient was a 64-year-old woman who developed in the setting of a fatal illness, pleural and pericardial effusions, pneumomediastinum, pneumoperitoneum, subcutaneous emphysema in the neck and chest, peripheral edema with weight gain of 43.4 lbs, marked hypoalbuminemia, abnormal liver tests, and renal failure. All the above pathologies led to a marked attenuation of the ECG voltage, and shortening of the mean P-wave, QRS complexes, and QTc interval durations. The postulated mechanism of the observed ECG phenomena is discussed.