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