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Congenital Heart Disease can result in ECG changes, often related to atrial or ventricular overload and enlargement. Below a list of relatively common forms of congenital heart disease and their potential ECG changes. Adapted from Khairy et al.<cite>khairy</cite> | |||
==Secundum atrial septal defect== | ==Secundum atrial septal defect== | ||
Information about [[w:Atrial_septal_defect|Secundum atrial septal defec on Wikipedia (external link)]] | |||
*[[Rhythm]]: normal sinus rhythm, increased risk of AF with age | *[[Rhythm]]: normal sinus rhythm, increased risk of AF with age | ||
*[[Conduction|PR interval]]: first degree AV block in 6-19% | *[[Conduction|PR interval]]: first degree AV block in 6-19% | ||
*[[Heart axis|QRS axis]]: 0° to 180°; RAD; LAHB | *[[Heart axis|QRS axis]]: 0° to 180°; RAD; LAD in Holt-Oram or LAHB | ||
*[[Chamber_Hypertrophy_and_Enlargment|Ventricular hypertrophy]]: | * QRS Configuration: rSr´ or rsR´ with RBBBi>RBBBc | ||
*Particularities: | * Atrial Enlargement: RAE 35% | ||
*[[Chamber_Hypertrophy_and_Enlargment|Ventricular hypertrophy]]: Uncommon | |||
*Particularities: "Crochetage" pattern | |||
==Ventricular Septal Defect== | ==Ventricular Septal Defect== | ||
Information about [[w:Ventricular_septal_defect|Ventricular Septal Defect on Wikipedia (external link)]] | |||
*[[Rhythm]]: normal sinus rhythm, PVCs | |||
*[[Conduction|PR interval]]: Normal or mild ↑; 1° AVB 10% | |||
*[[Heart axis|QRS axis]]: RAD with BVH; LAD 3% to 15% | |||
* QRS Configuration: Normal or rsr´; possible RBBB | |||
* Atrial Enlargement: Possible RAE±LAE | |||
*[[Chamber_Hypertrophy_and_Enlargment|Ventricular hypertrophy]]: BVH 23% to 61%; RVH with Eisenmenger | |||
*Particularities: Katz-Wachtel phenomenon | |||
==AV canal defect== | |||
Information about [[w:Atrioventricular_septal_defect|AV canal defect on Wikipedia (external link)]] | |||
*[[Rhythm]]: normal sinus rhythm, PVCs 30% | |||
*[[Conduction|PR interval]]: 1° AVB >50% | |||
*[[Heart axis|QRS axis]]: Moderate to extreme LAD; normal with atypical | |||
* QRS Configuration: rSr´ or rsR´ | |||
* Atrial Enlargement: Possible LAE | |||
*[[Chamber_Hypertrophy_and_Enlargment|Ventricular hypertrophy]]: Uncommon in partial; BVH in complete; RVH with Eisenmenger | |||
*Particularities: Inferoposteriorly displaced AVN | |||
==Patent ductus arteriosus== | |||
Information about [[w:Patent_ductus_arteriosus|Patent ductus arteriosus on Wikipedia (external link)]] | |||
*[[Rhythm]]: normal sinus rhythm, ↑ IART/AF with age | |||
*[[Conduction|PR interval]]: ↑ PR 10% to 20% | |||
*[[Heart axis|QRS axis]]: Normal | |||
* QRS Configuration: Deep S V<sub>1</sub>, tall R V<sub>5</sub> and V<sub>6</sub> | |||
* Atrial Enlargement: LAE with moderate PDA | |||
*[[Chamber_Hypertrophy_and_Enlargment|Ventricular hypertrophy]]: Uncommon | |||
*Particularities: Often either clinically silent or Eisenmenger | |||
==Pulmonary stenosis== | |||
Information about [[w:Pulmonary_valve_stenosis|Pulmonary stenosis on Wikipedia (external link)]] | |||
*[[Rhythm]]: normal sinus rhythm | |||
*[[Conduction|PR interval]]: Normal | |||
*[[Heart axis|QRS axis]]: Normal if mild; RAD with moderate/severe | |||
* QRS Configuration: Normal; or rSr´; R´ increases with severity | |||
* Atrial Enlargement: Possible RAE | |||
*[[Chamber_Hypertrophy_and_Enlargment|Ventricular hypertrophy]]: RVH; severity correlates with R:S in V<sub>1</sub> and V<sub>6</sub> | |||
*Particularities: Axis deviation correlates with RVP | |||
==Aortic coarctation== | |||
Information about [[w:Coarctation_of_the_aorta|Aortic coarctation on Wikipedia (external link)]] | |||
*[[Rhythm]]: normal sinus rhythm | |||
*[[Conduction|PR interval]]: Normal | |||
*[[Heart axis|QRS axis]]: Normal or LAD | |||
* QRS Configuration: Normal | |||
* Atrial Enlargement: Possible LAE | |||
*[[Chamber_Hypertrophy_and_Enlargment|Ventricular hypertrophy]]: LVH, especially by voltage criteria | |||
*Particularities: Persistent RVH rare beyond infancy | |||
==Ebstein’s anomaly== | |||
[[File:E000403.jpg|thumb|300px|ECG from a patient with Ebstein's anomaly showing huge P waves and low amplitude QRS waves. RBBB and T wave inversion are not present on this ECG.]] | |||
[[File:DVA0559.jpg|thumb|300px|ECG from a patient with Ebstein's anomaly]] | |||
Information about [[w:Ebstein's_anomaly|Ebstein's anomaly on Wikipedia (external link)]] | |||
*[[Rhythm]]: normal sinus rhythm, possible EAR, SVT; AF/IART 40% | |||
*[[Conduction|PR interval]]: 1° AVB common; short if WPW | |||
*[[Heart axis|QRS axis]]: Normal or LAD | |||
* QRS Configuration: Low-amplitude multiphasic atypical RBBB | |||
* Atrial Enlargement: RAE with Himalayan P waves | |||
*[[Chamber_Hypertrophy_and_Enlargment|Ventricular hypertrophy]]: Diminutive RV | |||
*Particularities: Accessory pathway common; Q II, III, aVF, and V<sub>1</sub>–V<sub>4</sub> | |||
{{clr}} | |||
==Surgically repaired TOF== | |||
Information about [[w:Tetralogy_of_Fallot|Surgically repaired TOF on Wikipedia (external link)]] | |||
*[[Rhythm]]: normal sinus rhythm, PVCs; IART 10%; VT 12% | |||
*[[Conduction|PR interval]]: Normal or mild ↑ | |||
*[[Heart axis|QRS axis]]: Normal or RAD; LAD 5% to 10% | |||
* QRS Configuration: RBBB 90% | |||
* Atrial Enlargement: Peaked P waves; RAE possible | |||
*[[Chamber_Hypertrophy_and_Enlargment|Ventricular hypertrophy]]: RVH possible if RVOT obstruction or PHT | |||
*Particularities: QRS duration±QTd predictive of VT/SCD | |||
==Congenitally corrected TGA== | |||
Information about [[w:Levo-Transposition_of_the_great_arteries|Congenitally corrected TGA on Wikipedia (external link)]] | |||
*[[Rhythm]]: normal sinus rhythm | |||
*[[Conduction|PR interval]]: 1° AVB >50%; AVB 2%/year | |||
*[[Heart axis|QRS axis]]: LAD | |||
* QRS Configuration: Absence septal q; Q in III, aVF, and right precordium | |||
* Atrial Enlargement: Not if no associated defects | |||
*[[Chamber_Hypertrophy_and_Enlargment|Ventricular hypertrophy]]: Not if no associated defects | |||
*Particularities: Anterior AVN; positive T precordial; WPW with Ebstein’s | |||
==Complete TGA/intra-atrial baffle== | |||
*[[Rhythm]]: Sinus brady 60%; EAR; junctional; IART 25% | |||
*[[Conduction|PR interval]]: Normal | |||
*[[Heart axis|QRS axis]]: RAD | |||
* QRS Configuration: Absence of q, small r, deep S in left precordium | |||
* Atrial Enlargement: Possible RAE | |||
*[[Chamber_Hypertrophy_and_Enlargment|Ventricular hypertrophy]]: RVH; diminutive LV | |||
*Particularities: Possible AVB if VSD or TV surgery | |||
==UVH with Fontan== | |||
*[[Rhythm]]: Sinus brady 15%; EAR; junctional; IART >50% | |||
*[[Conduction|PR interval]]: Normal in TA; 1° AVB in DILV | |||
*[[Heart axis|QRS axis]]: LAD in single RV, TA, single LV with noninverted outlet | |||
* QRS Configuration: Variable; ↑R and S amplitudes in limb and precordial leads | |||
* Atrial Enlargement: RAE in TA | |||
*[[Chamber_Hypertrophy_and_Enlargment|Ventricular hypertrophy]]: RVH with single RV; possible LVH with single LV | |||
*Particularities: Absent sinus node in LAI; AV block with L-loop or AVCD | |||
==Dextrocardia / Situs inversus== | |||
Information about [[w:Dextrocardia|Dextrocardia on Wikipedia (external link)]] | |||
[[File:Puzzle_2007_12_426_fig1.jpg|thumb|300px|An example of dextrocardia]] | |||
[[File:Situs_inversus.jpg|thumb|300px|Situs inversus]] | |||
[[File:Situs_inversus_mirrored_lead_positioning.jpg|thumb|300px|Dextrocardia with mirrored lead positioning]] | |||
*[[Rhythm]]: normal sinus rhythm, P-wave axis 105° to 165° with situs inversus | |||
*[[Conduction|PR interval]]: Normal | |||
*[[Heart axis|QRS axis]]: RAD | |||
* QRS Configuration: Inverse depolarization and repolarization | |||
* Atrial Enlargement: Not with situs inversus | |||
*[[Chamber_Hypertrophy_and_Enlargment|Ventricular hypertrophy]]: LVH: tall R V<sub>1</sub>–V<sub>2</sub>; RVH: deep Q, small R V<sub>1</sub> and tall R right lateral | |||
*Particularities: Situs solitus: normal P-wave axis and severe CHD | |||
{{clr}} | |||
==ALCAPA== | |||
Information about [[w:Anomalous_Left_Coronary_Artery_From_the_Pulmonary_Artery|ALCAPA on Wikipedia (external link)]] | |||
*[[Rhythm]]: normal sinus rhythm | |||
*[[Conduction|PR interval]]: Normal | |||
*[[Heart axis|QRS axis]]: Possible LAD | |||
* QRS Configuration: Ant-lat Q waves; possible ant-sept Q waves | |||
* Atrial Enlargement: Possible LAE | |||
*[[Chamber_Hypertrophy_and_Enlargment|Ventricular hypertrophy]]: Selective hypertrophy of posterobasal LV | |||
*Particularities: Possible ischemia | |||
==References== | |||
<biblio> | |||
#khairy pmid=18056539 | |||
</biblio> | |||