Effect of acute haemorrhage on QRS amplitude of the lead II canine electrocardiogram

OBJECTIVE: To examine the effect of acute haemorrhage on the QRS amplitude of the canine lead II surface electrocardiograph (ECG). DESIGN: Ten adult racing Greyhounds were tranquilised, anaesthetised, positioned in right lateral recumbency and connected to recording electrodes of an ECG unit. Baseline six-lead ECG traces were recorded, and further traces were obtained after one unit (460 mL) of blood, and then a second unit, were collected from the femoral artery. RESULTS: There was a consistent and progressive reduction in amplitude of the QRS complex in all leads during acute haemorrhage. QRS amplitude in lead II after removal of two units of blood averaged 74% of the baseline voltage, with individual values of 61 to 91% (P < 0.0001). There were even greater reductions in QRS amplitudes in lead aVL during haemorrhage. In three additional dogs, reductions in QRS voltages were shown to be accompanied by reductions in end-diastolic left ventricular internal dimensions measured echocardiographically. Furthermore, the effects of haemorrhage on the QRS amplitude and echocardiographic measurements were reversed when circulating blood volume was restored by re-infusion of blood removed previously. CONCLUSION: Acute haemorrhage corresponding to an approximately one-third reduction in blood volume caused a substantial reduction in QRS voltage of the surface ECG. It is postulated that this resulted from diminished ventricular distension as a consequence of reduced venous return. A similar mechanism may account for the small-amplitude ECG complexes associated with pericardial effusion, severe dehydration and hypovolaemia.