Hypertrophy and Atrial Enlargment

Question 1

Answer 1

1. RVH with straining pattern
2. RVH is diagnosed on ECG in the presence of
   
   1. a R/S ratio of greater than 1 in lead V1 in the absence of other causes
   2. if the R wave in lead V1 is greater than 7 millimeters tall.
3. The strain pattern occurs when
   
   1. the right ventricular wall is quite thick, and the pressure is high, as well.
   2. Strain causes ST segment depression and asymmetric T wave inversions in leads V1 to V3.

Question 2

Answer 2

1. Left Ventricular Hypertrophy

ECG Criteria

1. Sokolow-Lyon Criteria: Add the S wave in V1 plus the R wave in V5 or V6. If sum is greater than 35 mm: LVH is present.
2. Romhilt-Estes LVH Point Score System: If the score equals 4, LVH is present with 30% to 54% sensitivity. If the score is greater than 5, LVH is present with 83% to 97% specificity.
   
   1. Amplitude of largest R or S in limb leads ≥ 20 mm = 3 points
   2. Amplitude of S in V1 or V2 ≥ 30 mm = 3 points
   3. Amplitude of R in V5 or V6 ≥ 30 mm = 3 points
   4. ST and T wave changes opposite QRS without digoxin = 3 points
   5. ST and T wave changes opposite QRS with digoxin = 1 point
   6. Left Atrial Enlargement = 3 points

Question 4

Answer 4

p mitrale

LAE: The length of the P wave in lead II is greater than 120 milliseconds OR downward deflection of the P wave in lead V1 is greater than 40 milliseconds in length, with greater than 1 millimeter negative deflection (< -1 mm in amplitude)

P-Mitrale: occurs when the depolarization of the right atrium and left atrium are both visible in the P wave. This is seen as a notch in the P wave and occurs when the left atrium is markedly enlarged, such as in mitral valve stenosis.

Question 5

Answer 5

Left Ventricular Hypertrophy

ECG Criteria

1. Sokolow-Lyon Criteria: Add the S wave in V1 plus the R wave in V5 or V6. If sum is greater than 35 mm: LVH is present.
2. Romhilt-Estes LVH Point Score System: If the score equals 4, LVH is present with 30% to 54% sensitivity. If the score is greater than 5, LVH is present with 83% to 97% specificity.
   
   1. Amplitude of largest R or S in limb leads ≥ 20 mm = 3 points
   2. Amplitude of S in V1 or V2 ≥ 30 mm = 3 points
   3. Amplitude of R in V5 or V6 ≥ 30 mm = 3 points
   4. ST and T wave changes opposite QRS without digoxin = 3 points
   5. ST and T wave changes opposite QRS with digoxin = 1 point
   6. Left Atrial Enlargement = 3 points

Question 6

Answer 6

LAE

LAE: The length of the P wave in lead II is greater than 120 milliseconds OR downward deflection of the P wave in lead V1 is greater than 40 milliseconds in length, with greater than 1 millimeter negative deflection (< -1 mm in amplitude)

P-Mitrale: occurs when the depolarization of the right atrium and left atrium are both visible in the P wave. This is seen as a notch in the P wave and occurs when the left atrium is markedly enlarged, such as in mitral valve stenosis.

Question 7

Answer 7

RAE

Question 8

Answer 8

RVH

Question 9

Answer 9

LAE

Question 10

Answer 10

LAE

LAE: The length of the P wave in lead II is greater than 120 milliseconds OR downward deflection of the P wave in lead V1 is greater than 40 milliseconds in length, with greater than 1 millimeter negative deflection (< -1 mm in amplitude)

P-Mitrale: occurs when the depolarization of the right atrium and left atrium are both visible in the P wave. This is seen as a notch in the P wave and occurs when the left atrium is markedly enlarged, such as in mitral valve stenosis.

Question 11

Answer 11

biatrial enlargement