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A Specific ECG Triad Associated with Congestive Heart Failure
Author(s) -
Barold S. Serge,
GOLDBERGER ARY L.
Publication year - 1982
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1982.tb02285.x
Subject(s) - medicine , cardiology , heart failure , qrs complex , ejection fraction , cardiomyopathy , diastole , blood pressure
No specific ECG sign of congestive heart failure has been described. This report deiineales a new triad consisting of 1) High precordial QRS voltage (SV1 or SV2 + RV5 or RV6 ≥ 3.5 mV); 2) Relatively low limb lead voltage (total QRS amplitude ≤ 0.8 m V in the limb leads); 3) Poor precordial R wave progression (R/S ratio < 3 in V4). In a retrospective study of 27 patients with idiopathic congestive cardiomyopathy, this triad was noted on at least one occasion in 19 cases (70%). This pattern was not noted at all in a control group of 100 adults without heart disease or in a separate control group of 30 preoperative patients with left venlricular hypertrophy due to aortic valve disease and normal left ventricular function. Three of these patients subsequently developed this pattern as a false positive sign immediately following aortic valve replacement. In a prospective survey of ECGs from 2000 consecutive patients, this triad appeared in 32 cases (1.6% prevalence). Definite evidence of current or previous left ventricular failure, usually severe, was noted in 29 of these cases (91% predictive valuel as evidenced by pulmonary venous hypertension or pulmonary edema on chest x‐ray, left ventricular ejection fraction ≤ 40%, or echocardiographic left ventricular end‐diastolic dimension ≥ 6.0 cm. The pathophysiology of this highly specific ECG triad probably relates to a number of mechanical and vectorial factors associated with congestive heart failure of a variety of etiologies. Left ventricular enlargement causes increased precordial voltage. In addition, the horizontal plane vector shifts posteriorly, orthogonal to the frontal plane, causing poor R wave progression and low limb lead voltage. Finally, increased extracellular fluid may preferentially attenuate QRS voltage in the more distal (limb) leads. (PAGE, Vol. 5, July‐August, 1982)