Term
| what is cardiac enlargement? mechanism? |
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Definition
• Defined as either dilation or hypertrophy
• Dilation of a chamber refers to the muscle being
stretched and the chamber enlarging
• Mechanism is from volume overload • CHF
• Valvular insufficiency: aortic and mitral |
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Term
| what is cardiac hypertrophy? mechanism |
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Definition
• Hypertrophy is the increase in the size of the muscle mass, resulting in the ventricle being thick and powerful
• Mechanism is from pressure overload that creates a resistance that the heart has to pump against
• Aortic stenosis
• Systemic and/or pulmonary hypertension |
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Term
| When a chamber enlarges, three changes to ECG may occur: |
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Definition
• ECG wave may increase in duration due to the chamber taking longer to depolarize
• ECG wave may increase in amplitude due to the chamber generating more current and increasing the voltage
• ECG axis may be shifted due to a larger percentage of electrical current moving through the enlarged chamber |
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Term
| atrial enlargement examine what |
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Definition
• Examine the P waves in leads II and V1
• What is a normal P wave?
• SA node is located in RA
• Therefore the RA depolarizes first • P wave in V1 may be biphasic
-first part of p wave is right atrium, second part is left atrium |
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Term
| Left Atrial Abnormality ecg |
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Definition
• In V1 the LA depolarization will dominate
• This will create a wide and deep P wave which
will be asymmetric
• The terminal portion will be
• >0.04 seconds • >1 mm deep
• Not every biphasic P wave in V1=LAA!
• In lead II the P wave becomes prolonged
• P wave may be “notched” • Best seen in extremity leads
[image] |
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Term
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Definition
• Left-sided valvular disease
• Aortic insufficiency, aortic stenosis, mitral insufficiency, mitral
stenosis
• “P mitrale”—left atrial enlargement caused by left atrial dilatation or hypertrophy due to stenosis of the mitral valve
• Hypertensive heart disease • Cardiomyopathies
• Coronary artery disease` |
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Term
| Right Atrial Abnormality ecg |
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Definition
• Creates a tall P wave that is >2.5 mm in lead II • May also be seen in leads III and aVF
• In V1, if biphasic, then the first portion is tall (>2mm)
• P wave duration is not prolonged
[image] |
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Term
| right atrial enlargement etiologies |
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Definition
• Severe lung disease: COPD, PE
• Congenital heart disease: pulmonary valve stenosis, ASD, tetralogy of Fallot
• Usually associated with right ventricular hypertrophy
• “P pulmonale” |
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Term
| what is ventricular hypertrophy? v1, v3, v6? |
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Definition
• Generally, scan the QRS complexes in V1 and V6
• In ventricular hypertrophy, the QRS complex may be wider and have a greater magnitude than normal
[image] |
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Term
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Definition
• The criteria
• RV6(orV5)+SV1 > 35 mm
• RaVL > 11–13 mm
• RI+SIII > 25 mm
•RV5 orRV6 >25mm
• Largest R wave + deepest S wave > 45 mm
• “Strain” pattern in leads with tall R waves (V5,V6) |
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Term
| what causes LVH? etiologies? |
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Definition
• Most causes of LVH will also lead to LAA à
if there is evidence of LAA, look for LVH
• Etiology:
• Aortic stenosis
• Systemic hypertension
• Aortic insufficiency
• Mitral insufficiency
• Dilated cardiomyopathy |
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Term
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Definition
Now, here's a 62-year-old male with longstanding hypertension. Once again, we can look for the deepest S waves in V1. And I found one here, and I actually measured it for you already. It's 17 little boxes. And if you look at V6, this was 19 boxes. You can see even V5 is even taller. We could add that one in as well. But if we add the 17 and the 19, we get 36, which is greater than 35. So that means they have LVH.
Now, some of the other criteria, if we go back and look at some of our other criteria-- R in aVL being greater than 11. So if we look at aVL right here, is the R wave greater than 11 to 13 little boxes? It looks like it's 5, 10, maybe it's just at 13. So maybe it meets that criteria as well. |
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Term
| How Do We Determine RVH? v1, v3, v6? |
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Definition
• Height of R > depth of S in V1 is suggestive of RVH
• Usually accompanied by deep S wave in V5, V6, I, and aVL
• RV1 > 7 mm
• RIII > RII, in other words, RAD, suggests RVH
• Also look for indeterminate axis
• “Strain” pattern in right precordial leads
• RAA may occur with RVH
[image] |
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Term
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Definition
• 20-year-old female with increasing SOB and DOE
So here's one with a 20-year-old female with increasing shortness of breath and dyspnea on exertion. And these are aVR, the leads here. Here's all her chest leads. Here's V1. And look how positive V1 is. A normal V1 maybe would look like this, OK, predominantly negative. But look how positive that is. It's definitely greater than seven boxes. So this person has right ventricular hypertrophy. |
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Term
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Definition
• Congenital heart disease • Pulmonary valve stenosis
• Atrial septal defect
• Tetralogy of Fallot
• Mitral stenosis
• COPD
• Pulmonary hypertension |
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Term
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Definition
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