Atrial And Ventricular Enlargement

Question 1

ECG characteristics of Right Atrial Abnormality (RAA)?

Answer 1

RAA may produce an abnormally tall P wave ( 2.5 mm or more). They are, however, of limited sensitivity and specificity in the diagnosis of left atrial enlargement.

Question 2

Where can the characteristic tall, narrow P waves of RAA usually be seen best ?

Answer 2

In leads II, III , aVF, and sometimes V1.

Question 3

Four important causes of RAA ?

Answer 3

RAA is usually associated with right ventricular enlargement. Some causes are : Pulmonary Disease, Congenital Heart Disease, Acquired Triscupid Heart Disease, Cardiomyopathy such as Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia.

Question 4

ECG characteristics of Left Atrial Abnormality (LAA)?

Answer 4

LAA may cause an abnormally wide P wave with duration of 120 msec or more. The ECG sometimes shows a distinctive biphasic P wave.

Question 5

Clinically, LAA may occur with a variety of important settings, including ?

Answer 5

Valvular heart disease (aortic stenosis, aortic regurgitation, mitral regurgitation, and mitral stenosis) Hypertesive heart disease, cardiomyopathies (dilated, hypertrophic, and restricitve), coronary artery disease.

Question 6

Some findings of Right Ventricular Hypertrophy (RVH) ?

Answer 6

Tall right chest R waves, Right Axis Deviation (RAD) and T wave inversions in right to mid-precordial leads.

Question 7

Left Ventricular Hypertrophy can affect at least which ECG features ?

Answer 7

QRS voltages, repolarization (ST-T) changes, QRS axis and duration and P wave characteristics.

Question 8

Characteristics of LVH ?

Answer 8

1) SV1 + RV5 or RV6 > 35mm
2) SV3+ RaVL > 28mm for men, for women >20mm
3) R wave in aVL of 11- 13mm or more
4) ST-T changes, such as slight ST segment depression or T wave inversions.
5) horizontal electrical axis.
6) Signs of LAA (broad P waves in the extremity leads or biphasic P waves in lead V1 with a prominent negative, terminal wave).