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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?

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cardiac enlargement
Cardiac Enlargement
  • dilation
    • stretched
    • congestive heart failure
  • hypertrophy
    • increase size of heart muscle fibers
    • aortic stenosis
cardiac enlargement3
Cardiac Enlargement
  • Increase amount of cardiac tissue
  • How would this affect amount of depolarization?
  • How could that affect an ECG?
right atrial abnormality
Right Atrial Abnormality
  • Overload of the right atria
    • dilation
    • hypertrophy
  • Increase voltage of the P wave
right atrial abnormality5
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 abnormality6
Right Atrial Abnormality
  • Causes:
    • Pulmonary disease
    • Congenital heart disease
right atrial abnormality7
Right Atrial Abnormality
  • Tall P waves in any of the following leads:
    • II, III, aVF or sometimes V1.
right atrial abnormality8
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 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 abnormality10
Left Atrial Abnormality
  • CAD may produce wide P waves without left atrial enlargement.
left atrial abnormality11
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 abnormality12
Left Atrial Abnormality
  • Causes:
    • Valvular heart disease
    • Hypertensive heart disease
    • Cardiomyopathies
    • CAD
right ventricular hypertrophy
Right Ventricular Hypertrophy
  • What do you think will happen to the ECG with ventricular hypertrophy?
normal qrs
Normal QRS

V6?

V6?

V1?

V1?

FIG. 4-6

right ventricular hypertrophy16
Right Ventricular Hypertrophy
  • Consider right ventricular hypertrophy and V1

NORMAL

HYPERTROPHY

right ventricular hypertrophy19
Right Ventricular Hypertrophy
  • In V1, R wave is greater than the S wave
  • In V1, T wave inversion (reason unknown)
  • Right axis deviation
right ventricular hypertrophy20
Right Ventricular Hypertrophy
  • Causes of RVH
    • congenital heart disease
    • atrial septal defects
    • others
  • Emphysema may mask signs of RVH
left ventricular hypertrophy
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 hypertrophy24
Left Ventricular Hypertrophy
  • If S wave in V1 + R wave in either V5 or V6> 35 mm (not specific indicator).
  • R wave > 11-13 mm in aVL
  • ST segment changes
  • Left axis deviation
  • Left atrial abnormality
left ventricular hypertrophy26
Left Ventricular Hypertrophy
  • Causes:
    • Hypertension
    • Aortic stenosis
  • Risks of LVH
    • congestive heart failure
    • arrhythmias
left ventricular hypertrophy27
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