Chest lead tracings in arterial hypertension with cardlac enlargement

Abstract

An electrocardiographic pattern of the apical chest lead tracing in certain cases of arterial hypertension with cardiac enlargement has been presented. The ventricular complex in this tracing is characterized by a QRS which consists predominantly of a large negative component and by an upright T-wave. The pattern is essentially a modified standard Lead III, and is due, apparently, to the axillary situation of the exploring electrode. Examples of left heart enlargement in cases of rheumatic aortic insufficiency, some having negative, others positive. T-waves in stand ard Lead III, are presented for comparison to show that in these cases too, the apical chest lead tracing resembles standard Lead III. The left pectoral chest lead tracing is not appreciably altered in these cases, and, therefore, stands out in marked contrast with the apical lead. This lead, therefore, may serve in problems of differential diagnosis. In fact, the left pectoral lead is the chest lead of choice and the so-called apical lead should be avoided as a routine lead in cases of arterial hypertension with left heart enlargement.