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1 From the Cardiovascular Research Institute, the Cardiology Division of the Department of Medicine, and the John Henry Mills Echocardiography Laboratory of the University of California, San Francisco
Objective: This study was designed to determine the diagnostic value of 12-lead ECG for pericardial effusion and cardiac tamponade.
Design: Cross-sectional study.
Setting: University hospital.
Patients: Hospitalized patients with and without pericardial effusion and cardiac tamponade.
Measurements and results: In a blinded manner, we reviewed 12-lead ECGs from 136 patients with echocardiographically diagnosed pericardial effusions (12 of whom had cardiac tamponade) and from 19 control subjects without effusions. We examined the diagnostic value of three ECG signs: low voltage, PR segment depression, and electrical alternans. We found that all three ECG signs were specific but not sensitive for pericardial effusion (specificity, 89 to 100%; sensitivity, 1 to 17%) and cardiac tamponade (specificity, 86 to 99%; sensitivity, 0 to 42%). None of the ECG signs were associated with pericardial effusions of all sizes, but low voltage was associated with large and moderate pericardial effusions (odds ratio=2.5; 95% confidence interval [CI]=0.9 to 6.5; p=0.06) and with cardiac tamponade (odds ratio=4.7; 95% CI=1.1 to 21.0; p=0.004). In contrast, PR segment depression was associated only with cardiac tamponade (odds ratio=2.0; 95% CI=1.0 to 4.0; p=0.05), while electrical alternans was not associated with either pericardial effusion or cardiac tamponade.
Conclusions: Low voltage and PR segment depression are ECG signs that are suggestive, but not diagnostic, of pericardial effusion and cardiac tamponade. Because these ECG findings cannot reliably identify these conditions, we conclude that 12-lead ECG is poorly diagnostic of pericardial effusion and cardiac tamponade.
Key Words: cardiac tamponade • ECG • echocardiography • electrical alternans • electrocardiography • pericardial effusion • pericarditis • sensitivity • specificity
Submitted on October 12, 1995
Accepted on January 5, 1996
This article has been cited by other articles:
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  A. G. Habashy, A. Mittal, N. Ravichandran, and G. Cherian The Electrocardiogram in Large Pericardial Effusion: The Forgotten "P" Wave and the Influence of Tamponade, Size, Etiology, and Pericardial Thickness on QRS Voltage Angiology, May 1, 2004; 55(3): 303 - 307. [Abstract] [PDF]
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 Y. Kudo, F. Yamasaki, T. Doi, Y. Doi, and T. Sugiura Clinical Significance of Low Voltage in Asymptomatic Patients With Pericardial Effusion Free of Heart Disease Chest, December 1, 2003; 124(6): 2064 - 2067. [Abstract] [Full Text] [PDF]
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 C. Bruch, A. Schmermund, N. Dagres, T. Bartel, G. Caspari, S. Sack, and R. Erbel Changes in QRS voltage in cardiac tamponade and pericardial effusion: reversibility after pericardiocentesis and after anti-inflammatory drug treatment J. Am. Coll. Cardiol., July 1, 2001; 38(1): 219 - 226. [Abstract] [Full Text] [PDF]
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S. Atar, J. Chiu, J. S. Forrester, and R. J. Siegel Bloody Pericardial Effusion in Patients With Cardiac Tamponade* : Is the Cause Cancerous, Tuberculous, or Iatrogenic in the 1990s? Chest, December 1, 1999; 116(6): 1564 - 1569. [Abstract] [Full Text] [PDF]
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