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Nurse Susan
Nurse Susan, Nurse (RN)
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I recently had an EKG because I was scheduled for a total

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I recently had an EKG because I was scheduled for a total hysterectomy. I had to see a cardiologist before I could have the surgery. Everything was fine and I have never had shortness of breath or pain. The cardiologist did an echo for the benefit of the anestheolgist. He said my qrs was small (I think). And basically i had "low voltage." What does this mean? ( I also had a tiny leak in a valve that would have no effect on the surgery.)

Thank you for your question and I hope I can help explain things here. I don't know how familiar you are with what the EKG does and what it measures, please forgive me if I tell you what you may already know.

The heart beats in a specific rhythm in a specific order, and what regulates that order are electrical signals that are manufactured within the heart itself and sent to where they need to go. What the EKG does is take a "picture" of this electrical pattern...if the picture is not right, based on what looks wrong and where it is, we can determine where the problem lies and what the problem might be.

The patterns on a EKG are referred to as waves and complexes: the P wave, the QRS complex, and the T wave, and each one refers to a specific electrical event within the heart that tells it what to do. For example, the P wave is the first one you see, and it means that the atria...the top chambers of the heart...are depolarizing, ie getting its electrical signal from the SA (sinus atrial) node...which is the main pacemaker of the heart, the one that fires first, and the one that tells the heart to beat at its regular 60-90 beats per minute.

If you look at the EKG you will see tiny little boxes...each one of those boxes represents a short period of time. If the electrical signal is taking too long to travel, the wave form or complex will be wider. If however, the electrical signal is traveling faster than it should for any reason, that complex or wave will be a little narrower.

The QRS complex refers to the ventricles, and is about the way electricity moves through them. The QRS complex comes after the P wave. When you say your QRS complex was "small" that may refer to a QRS complex that was more narrow than it should be...meaning that the signal traveled faster than usual. If say, your ventricles were larger because you had an enlarged heart and so the electricity took longer to get from one side of the ventricle to the other, your QRS complex would be wider and abnormal and even could be taller. However, with a narrow QRS complex, often the beat is faster than it should be, and you did not state that, so I don't believe this is the case here, but am including this for completeness's sake.

Low voltage, however, refers to QRS complexes which are smaller in amplitude (height) than normal, so that is what I am guess your cardiologist meant. Essentially, whats happening here is that there is allot of insulation...and that insulation can be caused from relatively innocuous things from obesity (the fat doesn't conduct the electricity well to the electrodes) or pathological conditions like emphysema, pericarditis, pneumothorax, previous massive heart attack, scleroderma, and some others.

Your cardiologist did not seem concerned, so I am presuming you do not have one of the pathologically bad reasons for having a low voltage EKG.

This is a link on EKGs.

I was not sure if you wanted information about leaky valves...but between atria and ventricles, separating the two, and between the aorta and the heart are valves. It is the closing of two of these valves...the mitral and the bicuspid...which give us the familiar lub dub sound of the heart. But sometimes, for many reasons, the valves can get clogged or stiff, so they cant fully open and or they cant fully close. When that happens, that can cause the leak. The leak is blood from one chamber mixing with blood from another when thats not supposed to happen...leaks can be very tiny to quite large, and they can be heard as a heart murmur often. If yours is tiny, and non problematic that is a good thing. Just keep an eye on it as per your cardiologist. Ask him if you need antibiotics before you see the dentist, sometimes with some "leaks" that is the case.

I hope I was able to explain this well...and put your mind at ease.
Sincerely, ***** ***** luck with your upcoming surgery...
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