Chapter 8: Hypertrophy

Question 1

Hypertrophy of a chamber of the heart implies an increase in the thickness of the chamber wall, but ____ ________ is always present also.

Answer 1

some dilation

p. 244

Question 2

Hypertrophy may increase the ______ that the chamber contains.

Answer 2

volume

p. 244

Question 3

Although the term “atrial hypertrophy” is commonly used, enlargement of an atrium is usually due to ________ of the ______.
The general term ______ ___________ is preferred, since it includes both dilation and hypertrophy.

Answer 3

dilation, atrium
atrial enlargement
(p. 245)

Question 4

Because lead __ is directly over the atria, the _ ____ in __ is our best source of information about atrial enlargement.

Answer 4

V1, P wave, V1

p. 246

Question 5

With atrial enlargement, the P wave is usually…

Answer 5

…diphasic.

p. 247

Question 6

If the initial component of a diphasic P wave in lead V1 is the larger, then this indicates…

Answer 6

…right atrial enlargement.

p. 248

Question 7

If the height of the P wave in any of the limb leads exceeds ___ __ (even if not diphasic), suspect right atrial enlargement.

Answer 7

2. 5 mm

p. 248

Question 8

If the terminal portion of a diphasic P wave in V1 is large and wide, there is…

This terminal component is usually…

Answer 8

…left atrial enlargement.

…negative
p. 249

Question 9

Mitral stenosis can cause left atrial enlargement, but…

Answer 9

…systemic hypertension is the most common cause.

p. 249

Question 10

In lead V1, the QRS complex is mainly ________, and therefore the R wave is usually very _____.

Answer 10

negative, short

p. 250

Question 11

However, with Right Ventricular Hypertrophy, there is a large _ ____ in V1.

Answer 11

R wave

p. 251

Question 12

In right ventricular hypertrophy, the S wave in lead V1 is _______ than the R wave.

Answer 12

smaller

p. 251

Question 13

With right ventricular hypertrophy, the large R wave of V1 gets progressively smaller from __ to __ to __.
In the frontal plane, there will be _____ ____ _________, and in the horizontal plane, there is ________ ________ of the Mean Vector.

Answer 13

V2 to V3 to V4
right axis deviation, rightward rotation
(p. 252)

Question 14

In left ventricular hypertrophy, even more depolarization is going downward to the patient’s left – away from the positive V1 electrode. Therefore, the S wave is ____ ______ in V1. In general, hypertrophy of the L ventricle produces QRS complexes of increased _________, both in height and depth, especially in the _____ leads.

Answer 14

even deeper
amplitude, chest
(p. 253)

Question 15

With left ventricular hypertrophy, there is a large _ in V1 and a large _ in V5.

Answer 15

S
R
(p. 254)

Question 16

Depth (in mm) of _ in V1 plus the height of _ in V5, if greater than __ __, indicates left ventricular hypertrophy.

Answer 16

S
R
35 mm
(p. 255)

Question 17

The characteristic T wave that is commonly associated with L ventricular hypertrophy is…

Answer 17

…inverted and asymmetrical, with a long and gradual downslope, then a rapid, steep return up to the baseline.
(p. 256)

Question 18

Ventricular strain is characterized by…

Answer 18

…depression of the ST segment.

p. 257

Question 19

Ventricular hypertrophy may be associated with a ______ pattern. With ventricular strain, the ST segment becomes depressed and the mid-portion of the ST segment is slightly ______ upward. Also, the T wave is usually ________.

Answer 19

strain, humped
inverted
(p. 257)

Question 20

Lead V1 provides most of the information concerning hypertrophy of the heart’s chambers.
When routinely reading a 12 lead EKG, you should check lead I to see if the P waves are ________. Next, check the R wave in V1, then the _ ____ in V1, and then the _ ____ in V5.

Answer 20

diphasic
S wave
R wave
(p. 258)