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Atrial and Ventricular Enlargement

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Presentation on theme: "Atrial and Ventricular Enlargement"— Presentation transcript:

1 Atrial and Ventricular Enlargement
Chapter 6

2 Cardiac Enlargement dilation stretched congestive heart failure
hypertrophy increase size of heart muscle fibers aortic stenosis

3 Cardiac Enlargement Increase amount of cardiac tissue
How would this affect amount of depolarization? How could that affect an ECG?

4 Right Atrial Abnormality
Overload of the right atria dilation hypertrophy Increase voltage of the P wave

5 Right Atrial Abnormality
Normal P wave amplitude is less than 2.5 mm and seconds in width. Abnormal P waves are typically taller than 2.5 mm but not longer the 0.12 sec.

6 Right Atrial Abnormality
Causes: Pulmonary disease Congenital heart disease

7 Right Atrial Abnormality
Tall P waves in any of the following leads: II, III, aVF or sometimes V1.

8 Right Atrial Abnormality
P pulmonale artial enlargement due to severe pulmonary disease Atrial enlargement can occur in the absence of tall P waves.

9 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

10 Left Atrial Abnormality
CAD may produce wide P waves without left atrial enlargement.

11 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)

12 Left Atrial Abnormality
Causes: Valvular heart disease Hypertensive heart disease Cardiomyopathies CAD

13 Right Ventricular Hypertrophy
What do you think will happen to the ECG with ventricular hypertrophy?

14 Normal QRS V6? V6? V1? V1? FIG. 4-6

15 Normal QRS V1 V6

16 Right Ventricular Hypertrophy
Consider right ventricular hypertrophy and V1 NORMAL HYPERTROPHY



19 Right Ventricular Hypertrophy
In V1, R wave is greater than the S wave In V1, T wave inversion (reason unknown) Right axis deviation

20 Right Ventricular Hypertrophy
Causes of RVH congenital heart disease atrial septal defects others Emphysema may mask signs of RVH

21 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



24 Left Ventricular Hypertrophy
If S wave in V1 + R wave in either V5 or V6 > 35 mm (not specific indicator). R wave > mm in aVL ST segment changes Left axis deviation Left atrial abnormality

25 ST strain patterns

26 Left Ventricular Hypertrophy
Causes: Hypertension Aortic stenosis Risks of LVH congestive heart failure arrhythmias

27 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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