Download 5250-6-enlargement

Atrial and Ventricular
Enlargement
Chapter 6
Cardiac Enlargement
dilation
stretched
congestive heart failure
hypertrophy
increase size of heart muscle fibers
aortic stenosis
Cardiac Enlargement
Increase amount of cardiac tissue
How would this affect amount of depolarization?
How could that affect an ECG?
Right Atrial Abnormality
Overload of the right atria
dilation
hypertrophy
Increase voltage of the P wave
Right Atrial Abnormality
Normal P wave amplitude is less than 2.5 mm and
0.12 seconds in width.
Abnormal P waves are typically taller than 2.5 mm
but not longer the 0.12 sec.
Right Atrial Abnormality
Causes:
Pulmonary disease
Congenital heart disease
Right Atrial
Abnormality
•
Tall P waves in any of the following leads:
•
II, III, aVF or sometimes V1.
Right Atrial Abnormality
P pulmonale
artial enlargement due to severe pulmonary disease
Atrial enlargement can occur in the absence of tall P
waves.
Left Atrial Abnormality
Left atria normally depolarizes after the right atria.
Left atrial enlargement should prolong the P wave
greater than 0.12 sec.
P wave height may be normal or increased
Left Atrial Abnormality
CAD may produce wide P waves without left atrial
enlargement.
Left Atrial Abnormality
•
Leads I and/or II may
show notched P waves
•
•
•
(second hump due to
delayed depolarization of
the left atrium)
(P mitrale: mitral valve
disease)
V1 may show a bi-phasic
P wave
•
•
negative part is > 0.4 sec.
or 1 mm in depth
(right atria is anterior to the
left atria)
Left Atrial Abnormality
Causes:
Valvular heart disease
Hypertensive heart disease
Cardiomyopathies
CAD
Right Ventricular
Hypertrophy
What do you think will happen to the ECG with
ventricular hypertrophy?
Normal QRS
V6?
V6?
V1?
FIG. 4-6
V1?
Normal QRS
V1
V6
Right Ventricular
Hypertrophy
Consider right ventricular hypertrophy and V1
NORMAL
HYPERTROPHY
Right Ventricular
Hypertrophy
1. In V1, R wave is greater than the S wave
2. In V1, T wave inversion (reason unknown)
3. Right axis deviation
Right Ventricular
Hypertrophy
Causes of RVH
congenital heart disease
atrial septal defects
others
Emphysema may mask signs of RVH
Left Ventricular
Hypertrophy
With LVH, the electrical balance is tipped even
further to the left.
Predominate S waves in the right chest leads
Tall R waves in the left chest leads
Left Ventricular
Hypertrophy
• If S wave in V
+ R wave in either V5 or V6
> 35 mm (not specific indicator).
1
• R wave > 11-13 mm in aV
• ST segment changes
• Left axis deviation
• Left atrial abnormality
L
ST strain patterns
Left Ventricular
Hypertrophy
Causes:
Hypertension
Aortic stenosis
Risks of LVH
congestive heart failure
arrhythmias
Left Ventricular
Hypertrophy
High voltage can be seen in normal people,
especially athletes
Hypertrophy in both ventricles the ECG will show
more evidence of LVH