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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 l.jpg
Cardiac Enlargement

  • dilation

    • stretched

    • congestive heart failure

  • hypertrophy

    • increase size of heart muscle fibers

    • aortic stenosis


Cardiac enlargement3 l.jpg
Cardiac Enlargement

  • Increase amount of cardiac tissue

  • How would this affect amount of depolarization?

  • How could that affect an ECG?


Right atrial abnormality l.jpg
Right Atrial Abnormality

  • Overload of the right atria

    • dilation

    • hypertrophy

  • Increase voltage of the P wave


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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 l.jpg
Right Atrial Abnormality

  • Causes:

    • Pulmonary disease

    • Congenital heart disease


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Right Atrial Abnormality

  • Tall P waves in any of the following leads:

    • II, III, aVF or sometimes V1.


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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 l.jpg
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 l.jpg
Left Atrial Abnormality

  • CAD may produce wide P waves without left atrial enlargement.


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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 l.jpg
Left Atrial Abnormality

  • Causes:

    • Valvular heart disease

    • Hypertensive heart disease

    • Cardiomyopathies

    • CAD


Right ventricular hypertrophy l.jpg
Right Ventricular Hypertrophy

  • What do you think will happen to the ECG with ventricular hypertrophy?


Normal qrs l.jpg
Normal QRS

V6?

V6?

V1?

V1?

FIG. 4-6


Normal qrs15 l.jpg
Normal QRS

V1

V6


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Right Ventricular Hypertrophy

  • Consider right ventricular hypertrophy and V1

NORMAL

HYPERTROPHY


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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 l.jpg
Right Ventricular Hypertrophy

  • Causes of RVH

    • congenital heart disease

    • atrial septal defects

    • others

  • Emphysema may mask signs of RVH


Left ventricular hypertrophy l.jpg
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 l.jpg
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 l.jpg
Left Ventricular Hypertrophy

  • Causes:

    • Hypertension

    • Aortic stenosis

  • Risks of LVH

    • congestive heart failure

    • arrhythmias


Left ventricular hypertrophy27 l.jpg
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


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