From the Guidelines
A hiatal hernia can potentially cause low voltage with right P axis deviation and axis rotation on an electrocardiogram (EKG) due to the mechanical displacement of the stomach into the thoracic cavity, which may lead to a reduction in the electrical voltage generated by the heart and altered cardiac positioning 1.
Key EKG Findings
- Low voltage on EKG can be caused by various conditions, including mechanical displacement of the heart and lungs, which may be associated with a hiatal hernia
- Right P axis deviation may be observed due to altered thoracic anatomy and cardiac positioning associated with the hernia
- Axis rotation on EKG can also occur as a result of the changed cardiac orientation in the thoracic cavity
Clinical Implications
- The presence of a hiatal hernia may lead to gastroesophageal reflux disease (GERD), which can cause inflammation and further affect EKG readings
- Administration of medications such as metoclopramide or ranitidine may help alleviate symptoms and improve EKG readings by reducing gastric reflux and inflammation, although this is not directly supported by the provided evidence 1
Important Considerations
- The EKG findings associated with a hiatal hernia may be non-specific and can be influenced by various factors, including the size and location of the hernia, as well as the presence of underlying cardiac conditions
- A thorough clinical evaluation and additional diagnostic tests, such as imaging studies, may be necessary to confirm the presence of a hiatal hernia and its potential impact on EKG readings 1
From the Research
Causes of Low Voltage on EKG
- Low voltage on an electrocardiogram (EKG) can be caused by various conditions, including cardiac and extracardiac factors 2
- Cardiac causes include conditions such as cardiac amyloidosis and pericardial effusion with cardiac tamponade 3
- Extracardiac causes include peripheral edema, which can induce reversible low QRS voltage 2
Association with Hiatal Hernia
- There is no direct evidence in the provided studies to suggest that a hiatal hernia can cause low voltage with right P axis deviation and axis rotation on an EKG
- However, low voltage on an EKG can be associated with various conditions, and it is possible that a hiatal hernia could be related to one of these conditions, such as peripheral edema or cardiac disease
Clinical Significance of Low Voltage on EKG
- Low voltage on an EKG can be a marker of disease severity and a risk factor for adverse outcomes in patients with heart failure due to systolic dysfunction 4
- Low QRS voltage in limb leads can also indicate accompanying precordial voltage attenuation, resulting in underestimation of left ventricular hypertrophy 5
- Low precordial voltage can be associated with classic etiologies and left ventricular dilation 6