Survey
* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project
Download chapter 7
Document related concepts
no text concepts found
Transcript
12 chapter Chamber Enlargement Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 124 Chapter 12 Objectives • Identify, by criteria, evidence of right and left atrial enlargement • Identify evidence of right and left ventricular hypertrophy and strain • Describe the clinical implications of atrial and ventricular enlargement Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 125 Right Atrial Enlargement Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Causes of RAE • Congenital heart disease • Tricuspid or pulmonary valve disease • Pulmonary hypertension Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Clinical Problems • Not an acute problem • Seen with RVH • Can also be seen with large pulmonary embolism Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 126 Left Atrial Enlargement Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Left Atrial Enlargement • Left atrial dilation • Volume overload or pressure • Causes • Hypertension • Pulmonary edema • Mitral or aortic valve stenosis • Left ventricular hypertrophy • AMI Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Left Atrial Enlargement • Clinical implications • Keep in mind the • causes Can be useful in predicting hemodynamic problems Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 126 Right Ventricular Hypertrophy • Caused by increased pressure in the right ventricle • Large forces go away from the lateral leads and toward the right side Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ RVH • ECG Clues • • • • • RAE Narrow QRS RAD R wave height in V1 is ≥7mm or R>S Asymmetric downsloping of ST segment in inferior leads Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ RVH Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ RVH • Clinical Concerns • No specific treatment • Consider the causes for pathology • Can mimic posterior hemiblock: both have right axis deviation Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 127 Left Ventricular Hypertrophy • LVH-increased pressure or volume • Found in mitral and aortic stenosis, cardiomyopathy, hypertension, IHD • Experts disagree on ECG accuracy • Nonetheless, the criteria are proven Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ LVH ECG Criteria • LAE, plus any voltage criteria, is diagnostic • QRS is narrow or slightly widened with “strain” • Axis can be normal • > –15 may be LVH Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 127 LVH Voltage Criteria • “Rule of 35” • Measure the deepest S wave of V1 or V2 in mm (small squares) 17 • Measure the tallest R wave in Lead V5 or V6 • Add these two together 26 43 Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ LVH Voltage Criteria • If they add up to more than 35 mm, and the patient is over 35 years old, then voltage criteria for LVH is met • Then look for “strain” Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ LVH Voltage Criteria • R wave in aVL is >11 mm Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Strain Pattern • Increases sensitivity of voltage criteria • Downsloping ST segment, best seen in V5 or V6 Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Practice Cases Chamber Enlargement Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 128 Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 129 Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 129 Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 130 Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 130 Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 131 Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 132 Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ 133 Page, 12-Lead ECG for Acute and Critical Care Providers © 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Related documents