Johnston ECG Hypertrophy of Atria and Ventricles

Question 1

p waves in RAE

Answer 1

tall pointed, taller in III than in I

-p pumonale

Question 2

p waves in LAE

Answer 2

wide, notched; taller in I than in III

• AV valve disease
• 2nd half of p wave negative in V1 or III

Question 3

RAE leads to look in

Answer 3

II
III
aVF
amplitude greater than .25 (2.5mm)

Question 4

in LAE which lead would you see negative part of p wave

Answer 4

V1

Question 5

if you have an inverted p wave before QRS in leads 1,2,3 what do you think of

Answer 5

junctional rhythm

Question 6

voltage and QRS in LVH

Answer 6

voltage and interval of QRS complex will increase, producing a deeper S wave over RV and taller R waves over LV

Question 7

Sokolow Lyon Criteria

for LVH

Answer 7

(R in lead I) + (S in lead III) > 25

R in aVL > 11mm

R in V6 >26mm

Question 8

causes of RVH

Answer 8

chronic lung disease (COPD)

obstruction, VSD

congenital anomalies

MS and tricuspid regurg

Question 9

RVH in precordial leads

Answer 9

(chest leads)

R wave assume prominence in right precordial leads and deep S waves develop in left precordial leads

R:S ratio is greater than 1

Question 10

clues for RVH

Answer 10

RAD + 90 degrees or more

R in V1 is 7mm or more

R in V1 and S in V6 10mm or more

R/S ratio in V1 > 1

S/R ratio in V6 > 1

incomplete RBBB

ST-T strain pattern in II,III,aVF

P pulmonale

S1,S2,S3 pattern (children)

Question 11

causes of dominant R waves in V1

Answer 11

RVH
posterior or lateral MI
WPW
hypertrophic cardiomyopathy
muscular dystrophy
normal variant