Low EF Prediction From EKG

EKG findings that may increase suspicion for underlying LV systolic dysfunction or structural heart disease.

EKG Findings

+3 LBBB or paced rhythm

LBBB morphology or ventricular pacing

+2 QRS ≥120 ms

Bundle branch block or nonspecific intraventricular conduction delay

+2 Pathologic Q waves

Prior infarct pattern in contiguous leads

+1 Poor R-wave progression

Delayed or absent normal precordial R-wave progression

+2 LVH with strain

LVH voltage with lateral ST depression or T-wave inversion

+1 AF or atrial flutter

Current rhythm on EKG

+1 Frequent PVCs / NSVT

Frequent ectopy, couplets, or runs of nonsustained VT

+1 Low voltage

Limb leads <5 mm or precordial leads <10 mm

+1 Resting HR ≥100

Sinus tachycardia or atrial tachyarrhythmia

Interpretation

Low probability of low EF

No major EKG predictors selected.

EKG score

0 / 14

Few EKG markers of cardiomyopathy are present. Reduced EF is less likely, but cannot be excluded by EKG.

Positive findings

None selected

This is a clinical prediction aid rather than a validated substitute for echocardiography. Obtain TTE when clinically indicated regardless of the EKG score.

References

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