ECG & Ventricular/Atrial Hypertrphy

Question 1

What are some causes of LVH?

Answer 1

• Hypertension (most common)
• Aortic Stenosis
• Aortic regurgitation
• Coarctation of the aorta
• Hypertrophic cardiomyopathy

Question 2

How do you diagnose LVH on an ECG?

Answer 2

S-wave in V1 + R-wave in V5 or V6 is greater than 35 mm

or

R-wave >26-mm in either V5/6.

Question 3

What murmur causes an mid-systolic ejection murmur and why is it significant in LVH?

Answer 3

It is heard in Aortic stenosis - a cause of LVH.

Question 4

What other murmur has an mid-systolic ejection murmur?

Answer 4

Pulmonary stenosis

Question 5

What are some other ECG changes seen in LVH?

Answer 5

• U wave.
• Left Axis deviation.
• Elevated ST segements in V1-3 discordant to a deep depressed ST segment.

Question 6

If someone had left atrial enlargement, what would you see on an ECG?

Answer 6

A Bifid P Wave

(Remember M=Mitrale)

Question 7

If someone had right atrial enlargement, what would you see on ECG?

Answer 7

A peaked P wave

(Remember P for Pulmonale)

Question 8

How can you easily remember the difference between left and right atrial enlargement on an ECG?

Answer 8

• Bifid P wave = Mitrale = Left atrial hypertrophy >remember L is nearer to M
• Peaked P wave = remember giant P for Pulmonale. Right atrial hypertrophy > remember R is nearer to P

Question 9

If you think someone has atrial enlargement, what should you do?

Answer 9

Get an ECHO

Question 10

What mnemonic can you use to remember LVH in ECG?

Answer 10

Solo (1) Lion Roars and kills 35 people

Solo Lion (Sokolow-Lyon Criteria)

• S wave V1 (Solo is 1 for V1)
• R wave in V5 or V6 (ROARS has 5 letters)
• S wave + R wave = >35mm.

R-wave >26-mm in either V5/6.

Each large square is 5mm