From the Research
Management of a patient with low QRS voltage and septal infarcts requires a comprehensive approach focusing on both diagnosis confirmation and treatment of the underlying myocardial damage, with a priority on reducing morbidity, mortality, and improving quality of life. The presence of low QRS voltage in a patient with septal infarcts may indicate underlying conditions such as pericardial effusion, infiltrative cardiomyopathy, or extensive scarring, which can impact treatment and prognosis 1. Initial evaluation should include a 12-lead ECG, cardiac biomarkers (troponin, CK-MB), and echocardiography to assess ventricular function and wall motion abnormalities.
- Standard post-myocardial infarction therapy includes:
- Dual antiplatelet therapy with aspirin (81mg daily indefinitely) and a P2Y12 inhibitor such as clopidogrel (75mg daily for at least 12 months)
- High-intensity statins (atorvastatin 40-80mg or rosuvastatin 20-40mg daily)
- Beta-blockers (metoprolol succinate 25-200mg daily)
- ACE inhibitors or ARBs (lisinopril 5-40mg daily or valsartan 40-320mg daily) Low QRS voltage has been associated with increased mortality in various studies, including a recent study that found it to be an independent predictor of in-hospital mortality in acutely ill medical patients 2.
- Patients should be monitored for arrhythmias, particularly if the septal infarct affects the conduction system, and may require cardiac rehabilitation. Regular follow-up with serial echocardiograms is essential to monitor for complications such as ventricular remodeling, aneurysm formation, or heart failure development. The most recent and highest quality study on this topic is from 2018, which highlights the importance of considering QRS voltage as a predictor of in-hospital mortality 2.