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Chamber enlargement

Chamber enlargement

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Chamber enlargement

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  1. Chamber enlargement

  2. LVH Cornell criteria R aVL + S V3 = 28 (male); 20 (female); 24 (other books) Sokolov criteria R V5/6 + S V1 = 35 ( over 40 y.o); 40 (30-40 y.o.); 60 (16-30 y.o.) Precordial leads Max R + S = 45 R V5 = 26 R V6 = 20 LVH Limb Leads R Lead I + S II = 26 R Lead I = 12-14 R aVL = 11 - 12 S aVR = 15 R aVF = 20 - 21

  3. Hierarchy of diagnosis LBBB WPW LAFB should be coded with axis deviation ST segment effect from LVH Confounders that reduce sensitivity RVH amyloid, sarcoid pleural effusion body habitus COPD

  4. Other changes of LVH LAE LAD IVCD intrinsicoid deflection > 50 ms U waves no Q waves

  5. RVH RAD Dominant R wave R/S ratio V1, V3r > 1 R/S ratio V5/6 < 1 R wave V1 = 7 R V1 + S V5/6 = 11 qR in V1 RAE, ST changes right precordial leads Intrinsicoid deflection V1 < 40 ms Hierarchy/Confounder Inferior/posterior MI lateral MI RBBB LPFB WPW dextrocardia

  6. Combined LVH + RVH • LVH + RAD • LVH + Q aVR + R in V5 + T wave inversion in V1 • Large R = S in V3 and V4 (Kutz-Wachtel) • LVH + RAA

  7. RAA Tall P wave 2.5 mm in II, III, aVF tall P wave 1.5 mm in V1, V2 P axis > 70° Think, COPD, TOF, Eisenmenger, PE, RVH. LAA Biphasic P wave, terminal inverted > 40 ms in V1 notched P wave > 120 ms in II, III, aVF Think, MS, MR, AS, AI, CHF, LVH