EMU 365: Year around videos from North York General’s Emergency Medicine Update Conference

This EMU365 video features EM cardiology guru Dr. Amal Mattu on killer ECGs associated with pericardial effusions. He eloquently explains the utility of electrical alternans, specific lead and voltage criteria required to make the diagnosis of low voltage and more. 

EMU 365 Video -Killer ECGs with Amal Mattu

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Pericardial effusion (PCE) ECG 

  • Classic teaching: Electrical alternans (“classic” but occurs in <30%), tachycardia (may be blunted in patients on beta blockers), low voltage, cardiomegaly on CXR (sensitive but not specific)
  • PEARL: Tachycardia + low voltage = PCE until proven otherwise
  • Low voltage: QRS amplitude in I+ II +III <15 or V1+ V2 +V3 <30mm
  • Think PCE when patients present with SOB!
  • Low voltage ddx:
    • conduction blockage: fluid (PCE, pleural), air (COPD), tissue (obesity)
    • Low power: myxedema, cardiomyopathy, infiltrative disease
  • Avoid anticoagulation or antiplatelets until PCE is ruled out

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