Chapter 7 PowerPoint Flashcards
What leads to look at for axis deviation?
Lead I
aVf
+ lead 1 and + aVf?
Normal QRS axis
+ lead 1 and - aVf?
Left axis deviation
- lead 1 and + aVf?
Right axis deviation
- lead 1 and - aVf?
Extreme axis deviation
Chamber enlargements can be seen on ____?
ECG’s
How do chamber enlargements present themselves on ECGs?
Changes are noted in Amplitude, morphology, and duration of P wave, QRS complex, T wave or ST segments
What are the 3 different ways a chamber can be enlarged?
Increases in Tissue mass, Chamber Diameter, Intracardial Blood Volume
What is RAE?
Right Atrial Enlargement
Any condition that increases pressure to the right atria
4 different causes/pathophysiology of RAE?
Pulmonary system usually causing the pressure increases
-Atrial stenosis
-Pulmonary dysfunction
-Myocardial tissue scarring
-Atrial shunts
How does RAE appear on an ECG?
ECG appearance
Tall, symmetrical, peaked P waves in lead 2, >2.5mm
Biphasic P wave in V1
Pos > Neg portion
7 causes of RAE?
COPD
Obstructive Sleep Apnea
Tricuspid Valve Disease
Pulmonary Embolism
Cystic Fibrosis
Scarring of lung Tissue
Severe Kyphoscoliosis
Treatment for RAE (3)?
Benign
Focus is on treating Pulmonary conditions
Preventing clots
-Small clots are not deadly but damaging
-Large clots can lead to quick death
Pulmonary embolism has same signs and symptoms of ____?
MI
What does LAE result from (5)?
Left Atrial Enlargement
Results from Pressure overload associated with increased LV filling.
High Cardiac Output, Mitral Valve regurgitation, Arteriovenous fistula, L to R Shunt
How does LAE appear on an ECG?
ECG appearance
Wider than normal P wave, >.12 sec in Lead II
Biphasic P wave in V1, Neg>Pos, >1mm, >1mm Deep
4 causes of LAE?
Chronic hypertension
Heart failure
Mitral valve insufficiencies
Atrial Fibrillation
What typically occurs before LAE?
LVH
Treatment for LAE?
BP meds to stabilize LAE, manage by preventing enlargement
(No other specific treatment)
People who are ____ are at an increased risk of stroke?
Obese
Signs and symptoms of RVH?
Right ventricular hypertrophy (Often benign and asymptomatic)
If symptomatic, often respiratory issues: dyspnea, dizziness, syncope, edema of ankles & feet, frequent episodes of sinus tachycardia
How does RVH appear on an ECG?
R axis deviation >100°
Tall R waves in V1 & V2 > 7mm
RS ratio > 1 in V1 & V2
R Ventricular strain pattern [V1 and V2}
Down slopping ST segment w/ inverted T wave
(May be seen in Limb Leads II, III, aVf)
Deep s wave in L chest leads
What may or may not be present with RVH?
RAE may or may not be present
6 causes of RVH?
RV must work harder to circulate Blood to Pulmonary Artery
-COPD
-Pulmonary Valve Stenosis
-Pulmonary Hypertension
-Chronic Mitral Stenosis
-Congenital Lesions
-Tetralogy of fallot
Treatment for RVH?
ID underlying condition
Medications focused on breathlessness and respiratory restrictions
Pacemaker if HR needs regulated
With pulmonary disease, everything ____ goes ____?
With pulmonary disease, everything Right goes wrong
What four things can go wrong? (Clinical Tip: With pulmonary disease, everything Right goes wrong)
Right Axis Deviation
Right Atrial Enlargement
Right Ventricular Hypertrophy
Right Bundle Branch Block
What is LVH?
Left ventricular hypertrophy
Myocardial Blood Flow issues
Development of Diastolic dysfunction
-Increase in Diastolic pressure at rest and exercise
-Decrease in ejection fracture leading to congestive heart failure
What does LVH lead to if untreated?
If untreated LVH leads to Ventricular Arrythmias leading to sudden death
The appearance of ECG with LVH?
QRS complex increase
Taller than normal R waves
Deeper than normal S waves
S wave in V1 or V2 plus R wave in V5 or V6 > 35mm
LV strain pattern (Down slop ST segment and w/ inverted T wave)
Back up criteria
R wave > 11mm in aVL
S Wave in Lead I plus R Wave in Lead III > 25mm
Why does an ECG with LVH look the way it does?
ECG Appearances – As walls thicken, electrical impulses take longer to cross and arrive at epicardium
What is Romhilt-Estes Score?
A unique composite ECG criterion that determines probability of LVH
8 causes of LVH?
Stimulus of SNS
Chronic Systolic Hypertension
Elevated afterload
Aortic stenosis and insufficiency
Increased filling of LV
Coronary artery disease
Genetics
Mitral insufficiency
Treatment for LVH?
Control hypertension
Angiotensin II receptor blocker (ARB)
Angiotensin- Converting enzyme inhibitor (ACE)
