title: R-wave amplitude in lead II of an electrocardiograph correlates with central hypovolemia in human beings.
abstract: OBJECTIVE
  Previous animal and human experiments have suggested that reduction in central blood volume either increases or decreases the amplitude of R waves in various electrocardiograph (ECG) leads depending on underlying pathophysiology. In this investigation, we used graded central hypovolemia in adult volunteer subjects to test the hypothesis that moderate reductions in central blood volume increases R-wave amplitude in lead II of an ECG.
  
  
  METHODS
  A four-lead ECG tracing, heart rate (HR), estimated stroke volume (SV), systolic blood pressure, diastolic blood pressure, and mean arterial pressure were measured during baseline supine rest and during progressive reductions of central blood volume to an estimated volume loss of >1,000 mL with application of lower-body negative pressure (LBNP) in 13 healthy human volunteer subjects.
  
  
  RESULTS
  Lower-body negative pressure resulted in a significant progressive reduction in central blood volume, as indicated by a maximal decrease of 65% in SV and maximal elevation of 56% in HR from baseline to -60 mm Hg LBNP. R-wave amplitude increased (p < 0.0001) linearly with progressive LBNP. The amalgamated correlation (R2) between average stroke volume and average R-wave amplitude at each LBNP stage was -0.989.
  
  
  CONCLUSIONS
  These results support our hypothesis that reduction of central blood volume in human beings is associated with increased R-wave amplitude in lead II of an ECG.
authors.affiliation: U.S. Army Institute of Surgical Research, 3400 Rawley E. Chambers Avenue, Fort Sam Houston, TX 78234-6513. john.mcmanus@amedd.army.mil
authors.forename: John G
authors.initials: JG
authors.lastname: McManus
authors.forename: Victor A
authors.initials: VA
authors.lastname: Convertino
authors.forename: William H
authors.initials: WH
authors.lastname: Cooke
authors.forename: David A
authors.initials: DA
authors.lastname: Ludwig
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
mesh_terms: D000328:Adult; D001794:Blood Pressure; D003664:Decompression / Q000009:adverse effects; D017097:Electric Impedance; D004562:Electrocardiography; D006339:Heart Rate; D006439:Hemodynamics; D006470:Hemorrhage / Q000503:physiopathology; D006801:Humans; D020896:Hypovolemia / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D013318:Stroke Volume