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1、Atrial and Ventricular Enlargement,Chapter 6,Web Site Instruction,http:/ http:/library.med.utah.edu/kw/ecg/ecg_outline/Lesson7/index.html http:/library.med.utah.edu/kw/ecg/ecg_outline/Lesson8/index.html,Cardiac Enlargement,Dilation stretched e.g. congestive heart failure Hypertrophy increase size of
2、 heart muscle fibers e.g. aortic stenosis,Cardiac Enlargement,Increase amount/area of cardiac tissue How would this affect depolarization? How could that affect an ECG?,Right Atrial Abnormality,Overload of the right atria dilation hypertrophy also known as P pulmonale How would this change the P wav
3、e?,Right Atrial Abnormality,Right Atrial Abnormality,Normal P wave is less than 2.5 mm tall and 0.12 seconds wide. With right atrial hypertrophy, P waves are typically taller than 2.5 mm but not wider than 0.12 sec.,Right Atrial Abnormality Criteria,Tall P waves in lead II (or III, aVF and sometimes
4、 V1),Right Atrial Abnormality,Causes: Pulmonary disease Congenital heart disease,Left Atrial Abnormality,Also known as P mitrale Left atria normally depolarizes after the right atria. How would this affect the P wave? wider; left atrial enlargement should prolong the P wave 0.12 sec.,Left Atrial Abn
5、ormality,Left Atrial Abnormality,II: wide P wave V1: negative P wave is “1 box wide, 1 box deep”,Atrial Enlargement,Left Atrial Abnormality,Lead II (and I) show wide P waves (second hump due to delayed depolarization of the left atrium) (P mitrale: mitral valve disease) V1 may show a bi-phasic P wav
6、e 1 box wide, 1 box deep (biphasic since right atria is anterior to the left atria),Left Atrial Abnormality,Causes: Valve disease (mitral and aortic) Hypertensive heart disease Cardiomyopathies Coronary artery disease,Ventricular Hypertrophy,Frontal Plane,Transverse Plane,12 Leads,V1?,V1?,V6?,V6?,Fi
7、g. 4-6,Normal QRS,Normal QRS,Right Ventricular Hypertrophy,What do you think will happen to the ECG with ventricular hypertrophy?,Right Ventricular Hypertrophy,Consider right ventricular hypertrophy and V1 How would V1 be different?,Normal,Hypertrophy,Right Ventricular Hypertrophy,Right Ventricular
8、Hypertrophy Criteria,In V1, R wave is greater than the S wave - or - R in V1 greater than 7 mm Right axis deviation In V1, T wave inversion (reason unknown) S waves in V5 and V6,Right Ventricular Hypertrophy,Causes of RVH pulmonary disease congenital heart disease (Emphysema may mask signs of RVH) P
9、osterior wall MI may also show tall R waves in V1,Fig 6.8,R wave and T wave in V1?,What about the axis?,ECG Interpretation*,Rate RR interval Heart rate Rhythm PP interval P wave width, height, shape, etc. PR interval QRS width (and height) axis R wave progression abnormal Q waves QT interval ST segm
10、ent T waves U waves,*See Chapter 22,Fig 6.9,R wave in V1. P waves in II, III, & V1,T wave inversion PR interval,Left Ventricular Hypertrophy,With LVH, the electrical balance is tipped even further to the left.Tall R waves in the left chest leads Predominate S waves in the right chest leads,Left Vent
11、ricular Hypertrophy,Left Ventricular Hypertrophy Criteria,Sokolow-Lyon Voltage Criteria If S wave in V1 + R wave in V5 or V6 35 mm ( 50 for under 35 yrs of age) R wave 11 mm in aVL or I. Also LVH is more likely with a “strain pattern” or ST segment changes Left axis deviation Left atrial abnormality
12、,Left Ventricular Hypertrophy,Causes: Hypertension Aortic stenosis not always pathological Risks of LVH congestive heart failure arrhythmias,Left Ventricular Hypertrophy,High voltage can be seen in normal people, especially athletes With hypertrophy in both ventricles, the ECG will show more evidenc
13、e of LVH,ST strain patterns,LVH with ST strain pattern and LAE,Fig 6.10,Fig 6.11,LVH (in 20 yr old) without ST strain or LAE,Practice,RVH,Left atrial enlargement,Left ventricular hypertrophy (S wave V2 plus R wave of V5 greater than 35mm) and left atrial enlargement (II and V1).,LVH,Right atrial enl
14、argement,LVH,Right ventricular hypertrophy and right atrial enlargement.,RVH,Right axis deviation (predominant negative QRS in leads I and aVl) of QRS complex and qR pattern in V1 suggests severe right ventricular hypertrophy. Sharp P waves in inferior leads and V1 indicate right atrial overload. T
15、wave inersion in inferior and anterior leads are secondary to right ventricular hypertrophy.,Tall R waves in V4 and V5 with down sloping ST segment depression and T wave inversion are suggestive of left ventricular hypertrophy (LVH) with strain pattern. LVH with strain pattern usually occurs in pres
16、sure overload of the left ventricle as in systemic hypertension or aortic stenosis. Similar pattern may also occur in long standing severe aortic regurgitation, though the usual pattern in aortic regurgitation is left ventricular volume overload. Negative P waves in lead V1 is indicative of left atr
17、ial overload. Shallow T wave inversions are seen in inferior leads. Two supra ventricular ectopic beats are also seen in the rhythm strip. They are characterized by their premature nature, a P wave of different morphology preceding the QRS (in this case merging with the T wave of the previous beat), narrow QRS complex and an incomplete compensatory pause.,
