7 Right Atrial Abnormality Normal P wave is less than 2.5 mm tall and 0.12 seconds wide.With right atrial hypertrophy, P waves are typically taller than 2.5 mm but not wider than 0.12 sec.
8 Right Atrial Abnormality Criteria Tall P waves in lead II(or III, aVF and sometimes V1)
9 Right Atrial Abnormality Causes:Pulmonary diseaseCongenital heart disease
10 Left Atrial Abnormality Also known as P mitraleLeft atria normally depolarizes after the right atria.How would this affect the P wave?wider; left atrial enlargement should prolong the P wave > 0.12 sec.
14 Left Atrial Abnormality Lead II (and I) show wide P waves(second hump due to delayed depolarization of the left atrium)(P mitrale: mitral valve disease)V1 may show a bi-phasic P wave1 box wide, 1 box deep(biphasic since right atria is anterior to the left atria)
15 Left Atrial Abnormality Causes:Valve disease (mitral and aortic)Hypertensive heart diseaseCardiomyopathiesCoronary artery disease
30 Left Ventricular Hypertrophy Criteria Sokolow-Lyon Voltage CriteriaIf S wave in V1 + R wave in V5 or V6 ≥ 35 mm (≥ 50 for under 35 yrs of age)R wave > 11 mm in aVL or I...AlsoLVH is more likely with a “strain pattern” or ST segment changesLeft axis deviationLeft atrial abnormality
31 Left Ventricular Hypertrophy Causes:HypertensionAortic stenosisnot always pathologicalRisks of LVHcongestive heart failurearrhythmias
32 Left Ventricular Hypertrophy High voltage can be seen in normal people, especially athletesWith hypertrophy in both ventricles, the ECG will show more evidence of LVH
45 Right axis deviation (predominant negative QRS in leads I and aVl) of QRS complex and qR pattern in V1 suggests severe right ventricular hypertrophy. Sharp P waves in inferior leads and V1 indicate right atrial overload. T wave inersion in inferior and anterior leads are secondary to right ventricular hypertrophy.
46 Tall R waves in V4 and V5 with down sloping ST segment depression and T wave inversion are suggestive of left ventricular hypertrophy (LVH) with strain pattern. LVH with strain pattern usually occurs in pressure overload of the left ventricle as in systemic hypertension or aortic stenosis. Similar pattern may also occur in long standing severe aortic regurgitation, though the usual pattern in aortic regurgitation is left ventricular volume overload.Negative P waves in lead V1 is indicative of left atrial overload. Shallow T wave inversions are seen in inferior leads. Two supra ventricular ectopic beats are also seen in the rhythm strip. They are characterized by their premature nature, a P wave of different morphology preceding the QRS (in this case merging with the T wave of the previous beat), narrow QRS complex and an incomplete compensatory pause.
47 Right atrial overload (P pulmonale) and right ventricular hypertrophy Right atrial overload (P pulmonale) and right ventricular hypertrophy. Right atrial overload (enlargement) is manifest as tall sharp P waves in lead II and V1. The cut off values are P wave amplitude more than 0.25 mV in lead II and 0.1 mV or more in V1. Dominant R waves in V1 and deep S waves in V6 indicate right ventricular hypertrophy (RVH). Sokolow-Lyon for RVH criteria mentions that R wave in V1 + S wave in V5/V6 should be 1.1 mV or more. There is also a clockwise rotation in the QRS pattern between V1 to V6. QRS axis is around +120 degrees (aVR biphasic and lead III showing tallest QRS complex). Right axis deviation is also due to right ventricular hypertrophy. T wave inversion in inferior leads and V1 could be due to right ventricular hypertrophy itself. RVH in this case is type A with dominant R in V1 and deep S in V6. This type is seen in pulmonary stenosis. Type B RVH shows dominant R waves in V1 without deep S in V6. Deep S in V6 without dominant R in V1 seen in chronic obstructive lung disease with cor-pulmonale is called type C RVH. (Strictly speaking the types are classified depending upon vector cardiographic features and not based on scalar ECG)