When the ECG Goes Quiet: Transient Low Voltage in Systemic Capillary Leak Syndrome–Associated Myocardial Edema – a case report

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ID: 328943
2026
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Abstract
Abstract Background Systemic capillary leak syndrome (SCLS) is a rare disorder characterized by acute episodes of hypotension, hemoconcentration and hypoalbuminemia. Case summary A 50-year-old woman presented with shock triggered by influenza B infection. Despite aggressive fluid resuscitation, she developed multiorgan failure and was diagnosed with severe SCLS requiring veno-arterial extracorporeal membrane oxygenation due to myocardial edema. Electrocardiography demonstrated diffuse low QRS voltage, while echocardiography revealed severe biventricular dysfunction with marked myocardial edema. The patient was treated with immunoglobulins, corticosteroids, and plasmapheresis. Following clinical recovery, QRS voltages normalized and cardiac function fully recovered. Discussion SCLS is an immune-mediated rare cause of distributive shock. Cardiac involvement is uncommon but associated with high mortality. This case suggests that reversible low QRS voltage may serve as an electrocardiographic clue to myocardial edema and severe cardiac involvement.
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Authors Peter Kordis, Vanja Peršič, Andreja Černe Čerček, Milica Lukić, Misa Fister
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Journal European Heart Journal - Case Reports
Year 2026
DOI
10.1093/ehjcr/ytag694
URL
https://doi.org/10.1093/ehjcr/ytag694
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