The precordial lead of the electrocardiogram (Lead IV) as and aid in the recognition of active carditis in rheumatic fever

Robert L. Levy, Howard G. Bruenn

Research output: Contribution to journalArticlepeer-review

Abstract

1. 1. In rheumatic fever, if successive electrocardiograms are taken, Lead IV may furnish evidence of active carditis when changes indicating active myocardial involvement are not observed in the standard three leads. 2. 2. Frequently, gross variations in the contour of Lead IV indicate the significance of minor alterations in the three standard leads which might otherwise be regarded as of doubtful importance. This statement applies particularly to slight changes in the T-wave in Lead III. 3. 3. On occasion, changes denoting rheumatic lesions in the heart muscle are present in the first three leads when no change is apparent in Lead IV. 4. 4. In ambulatory patients with rheumatic heart disease, a single electrocardiogram may reveal evidence of myocardial damage in Lead IV only. On the basis of a single record, however, it is clearly not possible to establish the presence of rheumatic activity in the heart. 5. 5. Changes in the electrocardiogram characteristic of myocardial involvement were found in five patients whose hearts at autopsy showed lesions of active rheumatism. In two patients, in whom active rheumatic carditis was suspected during life but was not found at autopsy, the electrocardiograms were normal. 6. 6. In rheumatic fever the use of Lead IV is of clinical value as an aid in the recognition of active myocardial involvement and in following its course.

Original languageEnglish (US)
Pages (from-to)881-888
Number of pages8
JournalAmerican Heart Journal
Volume10
Issue number7
StatePublished - Oct 1935
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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