Chamber Hypertrophy and Enlargment: Difference between revisions

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Bij hypertrophy ontstaat er een verdikking van de hartspier. Dit kan verschllende oorzaken hebben. left ventrikelhypert treedt op bij overbelasting van de left ventrikel, zoals bij  hypertensie of aortaklepstenose. Rechter ventrikelhypertrophy treedt op bij overbelasting van de rechter ventrikel, zoals bij longziekten die een verhoogde longweerstand geven, zoals longemboliën en longemfyseem. Er bestaat ook een aangeboren vorm van hypertrophy: hypertrofische obstructieve cardiomyopathie.
In hypertrophy the heart muscle is thicker. This can have different causes. Left ventricular hypertrophy results from an increase in left ventricular workload, e.g. during hypertension or aortic valve stenosis. Right ventricular hypertrophy results from an increase in right ventricular workoad, e.g. emphysema or pulmonary embolisation.
These causes are fundamentally different from [[Miscellaneous#Hypertrophic_Obstructive_Cardiomyopathy|hypertrophic obstructive cardiomyopathy (HCM)]], which is a congenital misallignment of cardiomyocytes resulting in hypertrophy.  


left en rechter ventrikelhypertrophy geeft verschillende beelden op het ECG.
Left and right ventricular hypertrophy can be distinguished on the ECG:


==Criteria voor left ventrikelhypertrophy==
==Criteria for left ventricular hypertrophy==
[[Image:E_lvh.jpg|thumb]]
[[Image:E_lvh.jpg|thumb]]
[[Image:left_ventrikel_hypertrophy.GIF|thumb]]
[[Image:left_ventrikel_hypertrophy.GIF|thumb]]
[[Image:LVH.jpg|thumb|ECG van een patient met LVH volgens de Sokolow-Lyon criteria]]
[[Image:LVH.jpg|thumb|ECG of patient with left ventricular hypertrophy according to the Sokolow-Lyon criteria]]
As the left ventricular becomes thicker, the QRS complexes become larger. This is especially true for leads V1-V6. The S wave in V1 is deep, the R wave in V4 is high. Often some ST depression can be seen in leads V5-V6, which is in this setting is called a 'strain pattern'.


Bij hypertrophy van de leftventrikel worden de QRS-complexen qua hoogte en diepte veel groter dan normaal. Met name in de afleidingen V1-V6. Hierbij is in V1 de S-deflectie diep en in V5 de R-top hoog. Ook is er vaak ST depressie in de laterale afleidingen V5-V6, soms aangeduid met als een 'strain patroon'.
To diagnose left ventricular hypertrhophy on the ECG one of the following criteria should be met:
 
*R in V5 or V6 + S in V1 >35 mm. (this is called the Sokolow-Lyon criterium)
Om de diagnose LVH te stellen, moet een van de volgende criteria aanwezig zijn:
*R >26 mm in V5 or V6;  
*R in V5 of V6 + S in V1 >35 mm. (het zogenoemde Sokolow-Lyon criterium)
*R >20 mm in I, II or III;  
*R >26 mm in V5of V6;  
*R >12 mm in aVL (in the absence of [[Conduction delay#LAFB|left anterior fascicular block]]);
*R >20 mm in I, II of III;  
*R >12 mm in aVL (mits geen LAFB);
 
Het Cornell-criterium maakt onderscheid tussen mannen en vrouwen om de diagnose te kunnen stellen:
* R in aVL en S in V3 >28 mm bij mannen
* R in aVL en S in V3 >20 mm bij vrouwen


The Cornell-criterium has different values in men and women:
* R in aVL and S in V3 >28 mm in men
* R in aVL and S in V3 >20 mm in women
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==Criteria voor rechter ventrikelhypertrophy==
==Criteria for right ventricular hypertrophy==
[[Image:Rechter_ventrikel_hypertrophy.GIF|thumb|]]
[[Image:Rechter_ventrikel_hypertrophie.GIF|thumb|]]
[[Image:E_rvh.jpg|thumb|R groter dan S in V1]]
[[Image:E_rvh.jpg|thumb|Right ventricular hypertrohpy, the R wave is greater than the S wave in V1]]
Rechter ventrikelhypertrophy wordt met name veroorzaakt door longziekten en congenitale hartziekten. Op het ECG toont I een negatief QRS en V1 een positief QRS.  
Right ventricular hypertrophy occurs mainly in lung disease or in congenital heart disease.  
The ECG shows a negative QRS complex in I (and thus a right [[heart axis]]) and a positive QRS complex in V1.


*R > S in V1 (waarbij de R > 0.5 mV is)  
*R > S in V1 (R must be > 0.5 mV)  
*Rechter asdraai (>+90 graden)
*Right [[heart axis]]
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Revision as of 15:58, 20 May 2007

In hypertrophy the heart muscle is thicker. This can have different causes. Left ventricular hypertrophy results from an increase in left ventricular workload, e.g. during hypertension or aortic valve stenosis. Right ventricular hypertrophy results from an increase in right ventricular workoad, e.g. emphysema or pulmonary embolisation. These causes are fundamentally different from hypertrophic obstructive cardiomyopathy (HCM), which is a congenital misallignment of cardiomyocytes resulting in hypertrophy.

Left and right ventricular hypertrophy can be distinguished on the ECG:

Criteria for left ventricular hypertrophy

E lvh.jpg
File:Left ventrikel hypertrophy.GIF
ECG of patient with left ventricular hypertrophy according to the Sokolow-Lyon criteria

As the left ventricular becomes thicker, the QRS complexes become larger. This is especially true for leads V1-V6. The S wave in V1 is deep, the R wave in V4 is high. Often some ST depression can be seen in leads V5-V6, which is in this setting is called a 'strain pattern'.

To diagnose left ventricular hypertrhophy on the ECG one of the following criteria should be met:

  • R in V5 or V6 + S in V1 >35 mm. (this is called the Sokolow-Lyon criterium)
  • R >26 mm in V5 or V6;
  • R >20 mm in I, II or III;
  • R >12 mm in aVL (in the absence of left anterior fascicular block);

The Cornell-criterium has different values in men and women:

  • R in aVL and S in V3 >28 mm in men
  • R in aVL and S in V3 >20 mm in women


Criteria for right ventricular hypertrophy

File:Rechter ventrikel hypertrophie.GIF
Right ventricular hypertrohpy, the R wave is greater than the S wave in V1

Right ventricular hypertrophy occurs mainly in lung disease or in congenital heart disease. The ECG shows a negative QRS complex in I (and thus a right heart axis) and a positive QRS complex in V1.


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