Lead IV of the Electrocardiogram in Rheumatic Fever

Abstract

Summary

In acute rheumatic fever, lead IV of the electrocardiogram sometimes furnishes evidence of active carditis, when changes indicating myocardial involvement are not observed in the standard 3 leads. Frequently definite changes in lead IV render significant minor alterations in the first 3 leads which might otherwise be regarded as of doubtful importance. On occasion, changes denoting rheumatic lesions in the heart muscle may appear in the first 3 leads without change being present in lead IV. In ambulatory patients with rheumatic heart disease a single electrocardiogram may reveal evidence of myocardial damage in lead IV only. Obviously, a single record does not establish the presence of rheumatic activity in the heart.

Changes in the electrocardiogram characteristic of myocardial involvement were found in 5 patients whose hearts, at autopsy, showed the lesions of active rheumatism. In 2 cases in which active rheumatic carditis was suspected during life, but was not found at autopsy, the electrocardiograms were normal.

On the basis of these observations it is concluded that the use of lead IV of the electrocardiogram is of definite clinical value, as a supplement to the 3 standard leads, in the recognition of active myocardial involvement in rheumatic fever and in following its course.