Hypertrophy of Atria and Ventricles

Question 1

What are the first 4/7 causes of atrial enlargement? (IIVP)

Answer 1

Increase in volume of blood in the chamber
Increase in resistance to blood flow out of chamber
Volume overload or diastolic overload- dilation
Pressure overload or systolic overload-causes hypertrophy

Question 2

What are the last 3/7 causes of atrial enlargement? (GRL)

Answer 2

Good leads I, II, III, V1
RA activated first
LA activated later

Question 3

Describe the basic morphology of a P wave?

Answer 3

It should be rounded (not point, tall, peaked) (not notched, wide, “M shaped”)
Should not exceed 3 mm

Question 4

What does increased amplitude of the P wave mean?

Answer 4

Hypertrophy, HTN, AV valve disease, cor pulmonale, congenital problems

Question 5

What is the basic P wave morphology of RAE?

Answer 5

Tall, pointed with amplitude greater than .25 mv in leads II, III, aVF ; greater than .1 mv in leads V1 and V2.
P wave has a slight rightward axis
P- pulmonale

Question 6

What is the basic morphology of a P wave in LAE?

Answer 6

Wide, notched duration of .11 sec; taller in I than in III
P-mitrale
2nd half of P wave negative in V1 or III

Question 7

What diseases are associated with RAE?

Answer 7

TV disease and pulmonary HTN

COPD, PE, MS, MR, are causes of pulmonary HTN

Question 8

What are some diseases associated with LAE

Answer 8

MS or MR

Question 9

What are indicators of AV junctional Rhythm?

Answer 9

Inverted P waves in 2 and 3 with short P-R intervals

Question 10

What are some basic reasons for left ventricular hypertrophy?

Answer 10

volume (dilation) and pressure (hypertrophy)

Question 11

What are causes of LVH and what is most common?

Answer 11

HTN- most common

AS, AI, hypertrophic cardiomyopathy and coarctation of aorta

Question 12

What is the consequence of LVH?

Answer 12

The wall is thicker so the impulse will take longer to traverse it and arrive at epicardial surface

Question 13

What will happen to the voltage and interval of QRS complex during LVH?

Answer 13

Both increase producing deeper S wave over RV and taller R waves over LV

Question 14

Why should we use the term ventricular enlargement?

Answer 14

Because an ECG does not show the differences between concentric hypertrophy and dilation

Question 15

Discuss the sensitivity and specificity of LVH criteria

Answer 15

Lack sensitivity but are more specific

Question 16

What is a strain pattern with LVH?

Answer 16

Typical findings of LVH with increased R amplitude in the chest leads, to find strain look at the ST segments and if they are downward trending then that is strain!

Question 17

What are some causes of RVH? (3)

Answer 17

COPD, RVOT obstruction VSD

Question 18

What are some congenital causes of RVH? (3)

Answer 18

Tetraology of fallot, pulmonic stenosis, transposition of great vessels?

Question 19

What are some structural changes that can precipitate RVH? (2)

Answer 19

Mitral stenosis and tricuspid regurgitation

Question 20

What is the manifestation of RVH on ECG?

Answer 20

R wave assumes prominence in right precordial leads and deep S waves develop in left precordial leads
R:S ratio greater than 1

Question 21

What are the causes of dominant R waves in V1

Answer 21

RVH
Posterior or lateral MI
WPW
Hypertrophic cardiomyopathy
Muscular dystrophy
Normal variant