An unusual presentation of low QRS voltage in a patient with aortic aneurysm

There are many causes of low QRS voltage on the electrocardiogram (ECG). Although uncommon, there is evidence that an enlarged aorta can cause diminished QRS amplitude on ECG. In this case report, we describe an unusual presentation of low QRS voltage confined to the first three precordial leads (V1-V3) in a 77-year-old female with ascending aortic aneurysm. Analysis of the patient's medical history, echocardiogram and contrast-enhanced computed tomography indicates that the ECG pattern was caused by interposition of the aortic aneurysm between the heart and the skin electrodes (V1-V3), revealing a possible indirect sign for large aortic aneurysm on ECG.