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Cardiac Electrophysiology > 03 - Hypertrophy and Enlargement > Flashcards

03 - Hypertrophy and Enlargement Flashcards

0
Q

What is enlargement caused by?

A

Volume overload from aortic insufficiency or mitral regurgitation

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1
Q

Enlargement vs hypertrophy

A

Enlargement happens when the chamber dilates to accommodate an increased amount of blood
Hypertrophy refers to an increased muscle mass

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2
Q

What causes hypertrophy?

A

Pressure overload from systemic hypertension or aortic stenosis

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3
Q

Enlargement and hypertrophy cause ______ in wave duration, ______ in wave amplitude, and _____ of electrical axis

A

Increase - chamber takes longer to depol
Increase - chamber can generate more current
Shift - larger percentage of total current can move through expanded chamber

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4
Q

The ECG records the _________ of electrical forces at a given moment. The average vector of all of these is the _______. Its direction is called the

A

Instantaneous vector
Mean vector
Mean electrical axis

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5
Q

Complete depol can be represented by

A

Sequential vectors

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6
Q

The first vector represents ______ depol and each successive vector represents depol of the

A

Ventricles

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7
Q

The mean electrical axis points

A

Leftward and inferiorly

Represents the average during ventricular depol

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8
Q

Any mean QRS vector between -90 and +90 will produce positive QRS in

A

Lead I

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9
Q

Any mean QRS vector between 0 and 180 produces a positive QRS in

A

Lead aVF

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10
Q

If the QRS is positive in both lead I and aVF, the QRS axis lies between

A

0 and +90

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11
Q

With right axis deviation, the deflections will be positive in ______ and negative in ______ with the electrical axis between

A

aVF, lead I

+90 and 180

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12
Q

If the axis is between -90 and 180, this is called

The QRS complex will be

A

Extreme right axis deviation

Negative in both lead I and aVF

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13
Q

The electrical axis lies between 0 and 90 for

A

Left axis deviation

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14
Q

Left axis deviation has ______ aVF and ______ lead I

A

Negative

Positive

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15
Q

All of the information needed to assess atrial enlargement is on leads

A

II and V1

16
Q

Lead II is oriented ______ to the flow of current through atria

A

Parallel

17
Q

Lead V1 is oriented _______ to electrical flow

A

Perpendicularly

18
Q

In right atrial enlargement, amplitude of the first portion of the P wave ______, _____ in width, and P wave axis may shift _______

A

Increases
No change
Rightward, beyond 90

19
Q

Right atrial enlargement is often called

A

P pulmonale

20
Q

Left atrial enlargement is called

A

P mitrale

Mitral valve disease is a common cause

21
Q

The second portion of the P wave may increase in amplitude during

A

Left atrial enlargement

Increase in P wave duration

22
Q

In left atrial enlargement, the terminal portion of the P wave should

A

Drop at least 1 mm below baseline in V1

Increase by at least .04 sec in duration

23
Q

Causes of RVH?

A 
Pulm HTN
Tetrology of Fallot
Pulm valve stenosis
Ventricular septal defect
Pulm disease
24
Q

Why does RVH cause an electrical axis > 100 and right axis deviation?

A

It is reflective of the new electrical dominance of the usually “submissive” right ventricle

25
Q

In RVH, lead I is slightly more

A

Negative than positive

26
Q

No R wave progression
In V1, the R wave is larger than the S wave
In v6, the S wave is larger than the R wave

A

RVH

27
Q

Causes of LVH?

A

Hypertension
Aortic stenosis
Athleticism
Hypertrophic cardiomyopathy

28
Q

Left axis deviation in the limb leads can represent LVH but it is

A

Not very useful

29
Q

Which criteria of LVH is the most accurate and sensitive?

A

R wave in aVL > 14 mm

These are the others:
R wave in aVF > 21 mm
R wave in lead I > 14 mm
R wave in lead I plus S wave in lead III > 25

30
Q

In LVH, increased ____ amplitude over leads overlaying left ventricle

A

R wave

31
Q

In LVH, increased _____ amplitude in leads overlying the right ventricle

A

S wave

32
Q

Which criteria of LVH is the most selective and accurate?

A

R wave in V5 or V6 plus S wave in V1 or v2 exceeds 35 mm

Others:
R wave in V5 > 26 mm
R wave in V6 > 18 mm
R wave in V6 exceeds R wave in V5

33
Q

Global hypertrophy can cause ______ ST segment and T wave

A

Downsloping

Inversion

Cardiac Electrophysiology (5 decks)

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