ECG: Hypertrophy of Atria and Ventricles Flashcards
What are 4 best leads to see atrial enlargement?
I, II, III, and V1
What is the p-wave like in RAE and is taller in which lead?
Tall, pointed; taller in III than in I
What is the p-wave like in LAE and is taller in which lead?
Wide, notched (“M” shape); taller in I than in III
RAE is associated with what 2 etiologies?
- Tricuspid valvular disease
- Pulmonary HTN
In RAE the tall peaked P waves will have amplitude greater than ______mm in leads II, III, and aVF
>2.5 mm
What are 2 etiologies causing LAE?
Mitral stenosis and Mitral regurgitation
In LAE the second half of the P wave will be negative in which leads?
V1 or III
Interpret this EKG
LAE with 1st degree AV block
What is the most common cause of LVH?
Other causes?
- HTN = most common
- Also, AS, AI, hypertrophic cardiomyopathy and coarcatation of aorta
How does hypertrophy of the LV affect the electrical transmission as it passes through it and arrives at epicardial surface?
Effect on the QRS complex?
- Impulse will take longer = voltage and interval of QRS will increase
- Taller R waves over LV + deeper S waves over RV
Which feature of the ventricle is the main determinant of QRS voltage?
Total muscle mass
Criteria for LVH lack _______ (specificity/sensitivity), but are ______(sensitive/specific)
Criteria for LVH lack sensitivity, but are specific
Using the Romhilt-Estes Scoring System for LVH how many points is considered probably LVH and how many for dx of LVH?
- Probably LVH = 4
- LVH = 5
Using the Romhilt-Estes Scoring System for LVH, what size R or S in the limb leads, V1-V3, and V5-V6 is considered 3 points?
- R or S in limb lead = 20 mm or more
- S in V1-V3 = 25 mm or more
- R in V5-V6 = 30 mm or more
Using the Romhilt-Estes Scoring System for LVH, what type of axis deviation is worth 2 points?
LAD -30° or more
Using the Romhilt-Estes Scoring System for LVH, a QRS interval of how long is worth 1 point?
≥ .09 sec
Using the Romhilt-Estes Scoring System for LVH what ST finding is worth 3 points and which is worth 1 point?
- Any ST shift (WITHOUT digitalis) = 3 points
- Typical “strain” ST-T (WITH digitalis) = 1 point
Interpret this EKG
Left ventricular hypertrophy
Interpret this EKG; what do the arrows show?
LVH; arrows showing ST strain
List 4 etiologies responsible for RVH?
- COPD
- RVOT obstruction, VSD
- Congenital = TOF, pulmonic stnosis, and transposition of great vessels
- Valvular = Mitral stenosis, tricuspid regurgitation
What kind of axis deviation is a clue for RVH?
RAD +90° or MORE
Which leads with an R/S and S/R ratio >1 or more, is suggestive of RVH?
- R/S ratio >1 in V1
- S/R ratio >1 in V6
How big of an R in V1 is suggestive of RVH?
7 mm or more
How big of an R in V1 + S in V6 is suggestive of RVH?
10 mm or more
