THE ELECTROCARDIOGRAM IN CARDIOMYOPATHY

Abstract

The ecgs of 28 patients with obstructive cardiomyopathy, 25 with congestive cardiomyopathy, and 9 with constrictive cardiomyopathy have been studied and the findings compared with those of 18 patients with aortic valvular stenosis, 16 with ischemic heart disease, and 10 with constrictive pericarditis, respectively. No one specific ecg feature was noted either among the 3 types of cardiomyopathy studied or between them and the disease they resemble clinically. Among the 3 types of cardiomyopathy studied a tall R in leads I, V3, and V5, biventricular hypertrophy, and considerable QTc prolongation suggested the diagnosis of obstructive cardiomyopathy. Similarly a small r in leads V3 and V5, normal ventricular balance, prolonged QTc, atrial fibrillation, and heart block, suggested congestive cardiomyopathy. Generally low voltage, normal ventricular balance, or right ventricular hypertrophy with normal or slight QTc prolongation suggested constrictive cardiomyopathy. A tall R in V3, a right atrial P wave, combined ventricular hypertrophy, and absence of heart block favored a diagnosis of obstructive cardiomyopathy rather than aortic stenosis. Normal ventricular balance, heart block, and atrial fibrillation favoured congestive cardiomyopathy rather than ischemic heart disease. A normal P wave axis, a prolonged QTc, a normal sinus rhythm, T wave inversion in V4R with upright T waves in V1, V3, V5, and V7 favored the diagnosis of constrictive cardiomyopathy rather than constrictive pericarditis.