Congestive heart failure electrocardiogram

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Congestive Heart Failure Microchapters
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Acute Pharmacotherapy
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Chronic Pharmacotherapy in HFrEF Diuretics ACE Inhibitors Angiotensin receptor blockers Aldosterone Antagonists Beta Blockers Ca Channel Blockers Nitrates Hydralazine Positive Inotropics Anticoagulants Angiotensin Receptor-Neprilysin Inhibitor Antiarrhythmic Drugs Nutritional Supplements Hormonal Therapies Drugs to Avoid Drug Interactions Treatment of underlying causes Associated conditions
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Surgical Therapy: Biventricular Pacing or Cardiac Resynchronization Therapy (CRT) Implantation of Intracardiac Defibrillator Ultrafiltration Cardiac Surgery Left Ventricular Assist Devices (LVADs) Cardiac Transplantation
ACC/AHA Guideline Recommendations Initial and Serial Evaluation of the HF Patient Hospitalized Patient Patients With a Prior MI Sudden Cardiac Death Prevention Surgical/Percutaneous/Transcather Interventional Treatments of HF Patients at high risk for developing heart failure (Stage A) Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B) Patients with current or prior symptoms of heart failure (Stage C) Patients with refractory end-stage heart failure (Stage D) Coordinating Care for Patients With Chronic HF Quality Metrics/Performance Measures
Implementation of Practice Guidelines
Congestive heart failure end-of-life considerations
Specific Groups: Special Populations Patients who have concomitant disorders Obstructive Sleep Apnea in the Patient with CHF NSTEMI with Heart Failure and Cardiogenic Shock
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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:

• Amyloidosis
• Anasarca
• Dilated cardiomyopathy
• Chagas disease
• Diffuse coronary artery disease
• Congestive heart failure
• Generalized edema and pedal edema
• 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)

Electrocardiogram Assessment of Patients Presenting With Heart Failure (DO NOT EDIT)

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

• The CHF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Sources

• 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

• The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

• 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