Clockwise Rotation of the Heart in Patients With Acute Decompensated Heart Failure

Effects of heart failure status on electrocardiogram precordial leads and their value for monitoring body fluid changes in heart failure patients

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Changes in QRS morphology in ECG precordial leads and the value of these leads for identifying worsening heart failure (HF) have not been fully determined, though the effects of HF status on changes in QRS amplitude [1,2] and transitional zone [3,4] in these leads have been briefly described. When considering the right ventricle being more compliant than the left, it would be expected that expansion of the right ventricle is more than the left under the volume overload in worsening HF, and vice versa at its recovery [5], causing changes in QRS morphology in precordial leads.

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“…When considering the right ventricle being more compliant than the left, it would be expected that expansion of the right ventricle is more than the left under the volume overload in worsening HF, and vice versa at its recovery [5], causing changes in QRS morphology in precordial leads. This study examined the effects of changes in HF status on the S-wave in the right precordial leads [6], R-wave in the left precordial leads [7], and the transitional zone of precordial leads [3,4], and compared these ECG variables with b-type natriuretic peptide (BNP) [8].For the purposes of this study, we used a data base of monitoring HF patients between June 2003 and March 2009 [2,9]. The ECG data were included based on the availability of complete data set of both triplets of ECGs and simultaneous clinical data at the time of clinical stability, worsening, and recovery of HF.…”