Why Recording of an Electrocardiogram Should be Required in Every Inpatient and Outpatient Encounter of Patients with Heart Failure

The electrocardiogram (ECG) has not as yet realized its potential in the diagnosis and management of patients with heart failure (HF). The current model of using the ECG qualitatively with reference to the presence of arrhythmias, heart rate changes, hypertrophy, previous myocardial infarctions, ischemia, and conduction abnormalities is nonspecific and of modest value. The author argues, using examples, that the employment of the ECG metrics of amplitude(s) of leads aVR, sum of leads I & II, sum of all six limb leads, and dimensions and the area of the negative component of the P-wave from lead V1, in repeat ECGs from different clinical encounters, could provide the clinician with a powerful specific diagnostic and follow-up instrument in the management of the edematous state of patients with HF. Although eye-balling of changes in ECG hardcopies could suffice for this purpose, the increased availability at the point of care of automated measurements of ECG management systems renders application of these ideas all too easy. (PACE 2011;34:963-967)