The presence of anasarca can conceal the electrocardiographic
diagnosis of left ventricular hypertrophy (LVH), according to a
report in the October issue of the American Journal of Hypertension.

Anasarca peripheral edema has been reported to attenuate the
amplitude of QRS complexes, notes Dr. John E. Madias from Mount
Sinai School of Medicine of New York University. He evaluated
whether this could interfere with the ECG-based diagnosis of LVH.

LVH was present on the admission ECG of patients with anasarca, Dr.
Madias reports, but not on ECGs taken after patients reached half
their maximum weight gain or at the time of peak weight gain during
hospitalization. In contrast, LVH could be diagnosed from both
admission and discharge ECGs of control patients.

"Although LVH remained unaltered in the control subjects, the
precipitous drop of QRS potentials due to anasarca resulted in
levels below the threshold needed for a positive diagnosis of LVH,"
writes Dr. Madias. "Thus, it is probable that an interplay of the
amplitude of QRS complexes on admission and the relative weight gain
with anasarca determines whether criteria for a positive diagnosis
of LVH will be met."

He adds that a false negative diagnosis of LVH in patients with
anasarca is expected to be shared by patients with congestive heart
failure , who are known to have attenuated QRS complexes when they
are in their decompensated edematous state.

"For the diagnosis of LVH, ECG is being used daily by physicians in
decision making as a useful variable and is incorporated in almost
all prognostic indices," writes Dr. Madias. "Consequently,
familiarization with the link between accumulated body water and
reduction of the recorded ECG potentials and its consequences in the
accurate and reproducible diagnosis of LVH has important clinical
implications."

Am J Hypertens 2004;17:897-907