Content area
Full Text
In this issue of CHEST (see page 2064), Japan's leading investigator of pericardial disease, Tetsuro Sugiuru, MD, and his colleagues contribute a unique report of patients free of heart disease with asymptomatic pericardial effusions, small to large, some of whom had PR segment and ST-T wave changes. The report raises as many questions as it answers, and these will require further investigation. By standard definition, 32 of 121 patients had low voltage QRS. In the entire group, widespread ST-segment elevation was found in only 8 patients, and widespread PR-segment depression in 32 patients. PR-segment depressions were significantly more frequent in those with low QRS voltage than in those free of low voltage (more cases may have escaped detection when low voltage applied to more than the QRS complexes).1 The authors appropriately lumped moderate and large pericardial effusions, as it has been shown that the physiologic effect-increased ventricular interaction-of even asymptomatic effusions was similar in moderate-to-large effusions as opposed to small effusions.2
Eight of 32 patients with PR-segment deviations had ST-segment deviations, while none with isoelectric PR segments had ST deviations, and significantly more patients with isoelectric PH segments had moderate-to-large effusions than small effusions. Small voltage and PR-segment deviations were rare in patients who had clinically silent pericardial effusions with an unsurprising trend to lower voltage in moderate-to-large effusions.
Certain findings are relatively remarkable: all patients with PR deviations had either a malignancy or a connective tissue disease. In contrast, it is not surprising that all patients with hypothyroidism and with renal disease had no ECG changes.3
The authors conclude...