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ECG of the Enlarged Heart

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Presentation on theme: "ECG of the Enlarged Heart"— Presentation transcript:

1 ECG of the Enlarged Heart

2 The Cardiac Cycle

3 Know this During examination V follows S2 and should be
Visible with elevated JVP

4 Mitral Regurg

5 Aortic Regurg

6 Mitral Stenosis

7 Aortic Stenosis

8 What are the features of this ECG

9 Relations of ECG leads aVR RV

10 Characteristics of normal QRS complex
Width : 3 small squares or less In Lead V1, the depth of S wave is > than the height of R wave In Lead V5,V6, the height of R wave is always < 25mm In the left ventricular leads (V5, V6), presence of a septal Q wave is normal

11 Features of Left Ventricular Hypertrophy
Left axis deviation (look at inferior leads III or AVF) Tall R waves in lateral LV leads (aVL, V, VI - but not V/VI in a grossly enlarged heart) Deep S in septal/RV leads (III, V1 & V2) Delayed intrinsicoid deflection > 0.05s Strain pattern ST-T abnormalities

12 ESTES Criteria for LVH ("diagnostic", >5 points; "probable", 4 points)
+ECG Criteria Points Voltage Criteria (any of): R or S in limb leads >20 mm S in V1 or V2 > 30 mm R in V5 or V6 >30 mm 3 points ST-T Abnormalities: Without digitalis With digitalis 3 points 1 point Left Atrial Enlargement in V1 Left axis deviation 2 points QRS duration 0.09 sec 1 point Delayed intrinsicoid deflection in V5 or V6 (>0.05 sec)

13 Analyse Stephen’s ECG

14 RV Hypertrophy Right axis deviation
Tall R-waves in RV leads (look at aVR) Deep S-waves in LV leads ST-T changes

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