ECG 3: Chamber Hypertrophies

Question 1

right atrial enlargement

Answer 1

tall upright P wave (>2.5 mm)
Peaked appearance of P wave

Common etiologies:
chronic lung disease
pulmonary embolus

“Right is height” so tall P wave suggests right atrial enlargement. opposite, which is wide P wave, is for left atrial enlargement

Question 2

left atrial enlargement

Answer 2

prolonged duration of P wave >120 ms
widely notched P wave (>
40 ms)

common etiology:
mitral valve disease

“Right is height” so tall P wave suggests right atrial enlargement. *opposite, which is wide P wave, is for left atrial enlargement

Question 3

remarks on biatrial abnormality

Answer 3

The diagnosis of biatrial abnoramlity requires criteria for LAA and RAA to be met in either lead II, lead V1, or a combination of leads.

Question 4

RVH

Answer 4

Right axis deviation

Tall R in V1 ≥7 mm
Small S in V1 <2 mm
R/S ratio in V1 >1 with R >5 mm
qR in V1

Deep S in V5 or V6 >7 mm
Small R in V5, V6 <3 mm
R/S ratio in V5 or V6 <1

Question 5

LVH

Answer 5

SOKOLOW-LYON VOLTAGE CRITERIA
S in V1 + R in V5 or V6 > 3.5 mV (35mm)
R in AVL >1.1 mV (11 mm)

CORNELL VOLTAGE CRITERIA
R in aVL + S in V3 ≥ 2.8 mV for men
R in aVL + S in V3 ≥ 2.0 mV for women