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