In a few patients with hepatocellular carcinoma, metastasis to right ventricle may cause the ECG to show low voltage in limb leads, diffuse T-wave inversion and prolongation of the QT interval.

Abnormalities of cardiac electrophysiology may be noted in cases of hepatocellular carcinoma. Low voltage complexes in the limb leads may also be noticed in patients due to right ventricular metastasis. An ECG may be helpful in the diagnosis of metastatic hepatocellular carcinoma into the right ventricle.

Low voltage in limb leads and diffuse T-wave inversion

• Findings on an ECG suggestive of metastasis of hepatocellular carcinoma into the right ventricle include low voltage in limb leads and diffuse T-wave inversion^[1]

QT interval prolongation

• It is a sign of cirrhotic cardiomyopathy.^[2]
• It may be due to the following:
  • Circulating toxins in the blood stream
  • Drugs
  • Stress due to hemorrhage, shock or surgery (liver transplantation)

Attenuation of ECG voltage

• Attenuation of ECG voltages is noticed mainly in patients who have ascites and peripheral edema^[3]
• This finding may be corrected by placing leads cranially^[4]
• Peripheral edema may be strongly correlated with this finding
• Diuretic use in case of peripheral edema leads to improvement in ECG findings
• Paracentesis has no effect on ECG findings^[3]

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