Congestive Heart Failure ECG Triad
Congestive Heart Failure ECG Triad
Q1. The classic ECG triad of congestive heart failure includes:
The classic triad is LVH + Left atrial enlargement + nonspecific ST-T abnormalities.
Q2. Broad, notched P waves in lead II suggest:
Left atrial enlargement produces “P mitrale.”
Q3. The most common conduction abnormality in systolic heart failure is:
LBBB is strongly associated with advanced LV systolic dysfunction.
Q4. LV strain pattern in heart failure is represented by:
Strain pattern = ST depression & T inversion in lateral leads (I, aVL, V5–V6).
Q5. Atrial fibrillation in heart failure is primarily due to:
Atrial fibrillation is common in CHF due to left atrial enlargement.
Q6. Which of the following is a common arrhythmia in chronic heart failure?
Atrial fibrillation is the most common sustained arrhythmia in CHF.
Q7. Low voltage QRS complexes are most often seen in:
Low QRS voltages are typical of dilated cardiomyopathy or effusion.
Q8. Which bundle branch block is strongly associated with advanced systolic heart failure?
LBBB often reflects severe LV dysfunction in CHF.
Q9. The presence of Q waves in CHF patients usually indicates:
Pathological Q waves signify old MI, a common cause of CHF.
Q10. In decompensated CHF, the most common supraventricular rhythm is:
Atrial fibrillation is very frequent in CHF patients.
Q11. Which ECG change is suggestive of left atrial enlargement?
“P mitrale” indicates LA enlargement.
Q12. Heart failure with pulmonary hypertension can show which on ECG?
Pulmonary hypertension → Right ventricular hypertrophy.
Q13. In CHF, ST-T abnormalities are often due to:
LVH causes repolarization changes = strain pattern.
Q14. Which ECG finding is associated with poor prognosis in CHF?
LBBB predicts worse outcomes and may require CRT.
Q15. Nonspecific ST-T changes in CHF are most often seen in:
LV strain is most prominent in lateral leads.
Q16. In CHF, low QRS voltage may result from:
Effusion and cardiomyopathy can cause low voltages.
Q17. Which of the following is NOT typical of CHF ECG changes?
ST elevation in all leads suggests pericarditis, not CHF.
Q18. CHF patients with ventricular ectopy are at risk of:
Ventricular ectopy in CHF may progress to VT/VF.
Q19. The typical P-wave abnormality in CHF due to diastolic dysfunction is:
P mitrale = broad P wave due to LA enlargement.
Q20. ECG in advanced CHF often shows:
Advanced CHF commonly features tachycardia, AF, and conduction defects.
Congestive Heart Failure ECG Triad
“congestive heart failure triad” on an ECG is a specific pattern of findings, described by Barold and Goldberger, that includes (1) high precordial QRS voltage (large deflections in the chest leads), (2) low limb lead voltage (small deflections in the arm and leg leads), and (3) poor R-wave progression (the R wave in the chest leads doesn’t get progressively taller, especially in the earlier leads). This pattern suggests underlying cardiac hypertrophy and is associated with congestive heart failure (CHF).
Here’s a breakdown of the components:
- 1. High Precordial QRS Voltage:The R waves in the chest leads (especially V1 and V2) are unusually large, indicating significant ventricular hypertrophy, which can occur in CHF.
- 2. Low Limb Lead Voltage:The QRS complexes in the limb leads (I, II, III, aVR, aVL, aVF) are unusually small, a phenomenon sometimes seen in conditions like amyloidosis, which can lead to CHF.
- 3. Poor Precordial R-wave Progression:The R wave should normally get taller as you move from the right to the left side of the chest. In this triad, the R wave may not progress properly, or the R/S ratio in the precordial leads might be low.
Why it’s significant:
- This triad is a marker for CHF, particularly in patients with cardiomyopathies.
- It suggests an underlying cardiac condition leading to chamber enlargement or hypertrophy, which contributes to heart failure.
Important considerations:
- Not definitive: While helpful, this triad is not a definitive diagnosis of CHF. Other tests like echocardiography and clinical examination are essential for diagnosis and assessing prognosis.
- Associated conditions: The triad can be seen in conditions like cardiomyopathies.
- Other ECG findings: Other ECG findings in CHF can include evidence of prior infarction, chamber enlargement, arrhythmias, and conduction delays.
