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What is Voltage Discordance?
- On occasion there may be low voltage in the limb leads (ie, all QRS voltage in the limb leads ≤5 mm) — but normal QRS voltage in the chest leads. This is called, “Voltage Discordance” (Chinitz et al — J Electrocardiol 41(4):281-286, 2008).
- Low voltage isolated to the limb leads will be associated with the usual list of potential causes in only about 50% of cases. (Click here for our discussion on Low Voltage).
- In the remainder of cases of “Voltage Discordance” — the patient will have a dilated cardiomyopathy. Physiologic explanation for why this ECG phenomenon is seen is discussed in 7 sequential figures below (adapted from a PDF presentation by Ahmed ElBorae, MSc — 2022, from Cairo University).
