Congestive heart failure electrocardiogram: Difference between revisions

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{| class="infobox" style="float:right;"
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| [[File:Siren.gif|30px|link= Heart failure resident survival guide]]|| <br> || <br>
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{{Congestive heart failure}}
{{Congestive heart failure}}
{{CMG}}
{{CMG}}; {{AOEIC}} {{LG}}
 
==Overview==
Although there is no diagnostic criteria of congestive heart failure on the EKG, there may be signs of the underlying cardiac cause(s) of congestive heart failure.
 
==Electrocardiogram==
====[[Low QRS Voltage]]:====
*The EKG often shows [[low QRS voltage]].  There are two broad underlying causes of low QRS voltage in the patient with heart failure:
:#Electrically inert [[myocardium]] due to a loss of viable [[myocardium]]
:#Infiltration of the myocardium ([[myxedematous]], [[Chagas disease]])
 
*In alphabetical order the differential diagnosis of causes of [[low QRS voltage]] in the patient with heart failure includes:
 
:* [[Amyloidosis]]
:* [[Anasarca]]<ref name="pmid18804788">{{cite journal| author=Madias JE| title=Low QRS voltage and its causes. | journal=J Electrocardiol | year= 2008 | volume= 41 | issue= 6 | pages= 498-500 | pmid=18804788 | doi=10.1016/j.jelectrocard.2008.06.021 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18804788  }} </ref>
:* Dilated [[cardiomyopathy]]<ref name="pmid18353352">{{cite journal| author=Chinitz JS, Cooper JM, Verdino RJ| title=Electrocardiogram voltage discordance: interpretation of low QRS voltage only in the limb leads. | journal=J Electrocardiol | year= 2008 | volume= 41 | issue= 4 | pages= 281-6 | pmid=18353352 | doi=10.1016/j.jelectrocard.2007.12.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18353352  }} </ref>
:* [[Chagas disease]]
:* Diffuse [[coronary artery disease]]
:* [[Congestive heart failure]]
:* [[Generalized edema]] and [[pedal edema]]<ref name="pmid18804788">{{cite journal| author=Madias JE| title=Low QRS voltage and its causes. | journal=J Electrocardiol | year= 2008 | volume= 41 | issue= 6 | pages= 498-500 | pmid=18804788 | doi=10.1016/j.jelectrocard.2008.06.021 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18804788  }} </ref>
:* [[Hypothyroidism]]
:* Prior [[myocardial infarction]]
:* [[Myocarditis]]
:* [[Myxedema]]
:* [[Obesity]]
:* [[Tamponade]]
 
====Poor R wave progression:====
:[[Poor R wave progression]] in the precordial leads may be secondary to a prior [[myocardial infarction]] but can also be observed in the absence of a prior myocardial infarction in the patient with heart failure.
 
====Left bundle branch block (LBBB):====
:[[Left bundle branch block]] ([[LBBB]]) can be observed in both ischemic and non-ischemic cases of [[heart failure]].
 
====Left ventricular hypertrophy:====
:Changes of [[left ventricular hypertrophy]] consistent with a history of [[hypertension]] can be seen
 
====Left atrial enlargement:====
:Dilation of the [[left atrium]] can occur in congestive heart failure and the accompanying EKG abnormalities can be observed on the EKG.
 
====Non-specific ST segment and T wave changes:====
:[[T wave]] and [[ST segment]] inversions and flattening can be observed in heart failure.
 
==2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult (DO NOT EDIT) <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>==
 
===Electrocardiogram Assessment of Patients Presenting With Heart Failure (DO NOT EDIT) <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref><ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>===
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
 
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Twelve-lead [[electrocardiogram]] and [[Congestive heart failure chest x ray|chest radiograph]] (PA and lateral) should be performed initially in all patients presenting with [[heart failure]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
 
{|class="wikitable" style="width:80%"
|-
|colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Routine use of signal-averaged [[electrocardiography]] is not recommended for the evaluation of patients presenting with [[heart failure]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|}
 
{|class="wikitable" style="width:80%"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[Holter monitoring]] might be considered in patients presenting with [[heart failure]] who have a history of [[myocardial infarction]] and are being considered for electrophysiologic study to document [[ventricular tachycardia]] inducibility. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>


== Overview==
|}


==Vote on and Suggest Revisions to the Current Guidelines==
*[[The Living Guidelines: Diagnosis and Management of Chronic Heart Failure | The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]


== References==
==Sources==
*[https://www.ahajournals.org/doi/epub/10.1161/CIR.0000000000001063.full.pdf 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines]<ref name="pmid35363499">{{cite journal |vauthors=Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW |title=2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines |journal=Circulation |volume=145 |issue=18 |pages=e895–e1032 |date=May 2022 |pmid=35363499 |doi=10.1161/CIR.0000000000001063 |url=}} </ref>
 
*[http://circ.ahajournals.org/content/112/12/e154.full.pdf The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult] <ref name="Hunt"> Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202</ref>
 
*[http://content.onlinejacc.org/cgi/reprint/53/15/1343.pdf 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation] <ref name="pmid19324967">Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19324967 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.] ''Circulation'' 119 (14):1977-2016. [http://dx.doi.org/10.1161/CIRCULATIONAHA.109.192064 DOI:10.1161/CIRCULATIONAHA.109.192064] PMID: [http://pubmed.gov/19324967 19324967]</ref>
 
==References==
{{Reflist|2}}
{{Reflist|2}}
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{{WikiDoc Sources}}


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Latest revision as of 20:45, 22 June 2022
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

Although there is no diagnostic criteria of congestive heart failure on the EKG, there may be signs of the underlying cardiac cause(s) of congestive heart failure.

Electrocardiogram

Low QRS Voltage:

  • The EKG often shows low QRS voltage. There are two broad underlying causes of low QRS voltage in the patient with heart failure:
  1. Electrically inert myocardium due to a loss of viable myocardium
  2. Infiltration of the myocardium (myxedematous, Chagas disease)
  • In alphabetical order the differential diagnosis of causes of low QRS voltage in the patient with heart failure includes:

Poor R wave progression:

Poor R wave progression in the precordial leads may be secondary to a prior myocardial infarction but can also be observed in the absence of a prior myocardial infarction in the patient with heart failure.

Left bundle branch block (LBBB):

Left bundle branch block (LBBB) can be observed in both ischemic and non-ischemic cases of heart failure.

Left ventricular hypertrophy:

Changes of left ventricular hypertrophy consistent with a history of hypertension can be seen

Left atrial enlargement:

Dilation of the left atrium can occur in congestive heart failure and the accompanying EKG abnormalities can be observed on the EKG.

Non-specific ST segment and T wave changes:

T wave and ST segment inversions and flattening can be observed in heart failure.

2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult (DO NOT EDIT) [3][4]

Electrocardiogram Assessment of Patients Presenting With Heart Failure (DO NOT EDIT) [3][4]

Class I
"1. Twelve-lead electrocardiogram and chest radiograph (PA and lateral) should be performed initially in all patients presenting with heart failure. (Level of Evidence: C) "
Class III (No Benefit)
"1. Routine use of signal-averaged electrocardiography is not recommended for the evaluation of patients presenting with heart failure. (Level of Evidence: C) "
Class IIb
"1. Holter monitoring might be considered in patients presenting with heart failure who have a history of myocardial infarction and are being considered for electrophysiologic study to document ventricular tachycardia inducibility. (Level of Evidence: C) "

Vote on and Suggest Revisions to the Current Guidelines

Sources

References

  1. ↑ 1.0 1.1 Madias JE (2008). "Low QRS voltage and its causes". J Electrocardiol. 41 (6): 498–500. doi:10.1016/j.jelectrocard.2008.06.021. PMID 18804788.
  2. ↑ Chinitz JS, Cooper JM, Verdino RJ (2008). "Electrocardiogram voltage discordance: interpretation of low QRS voltage only in the limb leads". J Electrocardiol. 41 (4): 281–6. doi:10.1016/j.jelectrocard.2007.12.001. PMID 18353352.
  3. ↑ 3.0 3.1 3.2 Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202
  4. ↑ 4.0 4.1 4.2 Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967
  5. ↑ Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW (May 2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e895–e1032. doi:10.1161/CIR.0000000000001063. PMID 35363499 Check |pmid= value (help).

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