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Chamber Hypertrophy and Enlargment: Difference between revisions
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==Left ventricular hypertrophy== | ==Left ventricular hypertrophy== | ||
[[Image:E_lvh.jpg|thumb|LVH. R in V5 is 26mm, S in V1 in 15mm. The sum is 41 mm which is more than 35 mm and therefore LVH is present according to the Sokolow-Lyon criteria.]] | [[Image:E_lvh.jpg|thumb|left|300px|LVH. R in V5 is 26mm, S in V1 in 15mm. The sum is 41 mm which is more than 35 mm and therefore LVH is present according to the Sokolow-Lyon criteria.]] | ||
[[Image:LVH.png|thumb]] | [[Image:LVH.png|thumb|250px]] | ||
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'. | 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'. | ||
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Left ventricular hypertrophy has prognostic consequences as has been found in several studies.<cite>Levy</cite><cite>Sundstrom</cite> | Left ventricular hypertrophy has prognostic consequences as has been found in several studies.<cite>Levy</cite><cite>Sundstrom</cite> | ||
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=== | ===Example=== | ||
<gallery> | <gallery> | ||
Image:LVH.jpg|ECG of patient with left ventricular hypertrophy according to the Sokolow-Lyon criteria | Image:LVH.jpg|ECG of patient with left ventricular hypertrophy according to the Sokolow-Lyon criteria | ||
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==Right ventricular hypertrophy== | ==Right ventricular hypertrophy== | ||
[[Image:RVH.png|thumb]] | [[Image:RVH.png|thumb|left]] | ||
[[Image:E_rvh.jpg|thumb|Right ventricular hypertrohpy, the R wave is greater than the S wave in V1]] | [[Image:E_rvh.jpg|thumb|450px|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. | 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. | 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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==Left atrial enlargement== | ==Left atrial enlargement== | ||
<div style="float:right;margin-left:10px"> | |||
<gallery> | |||
Image:left_atrial_enlargement.jpg| Left atrial enlargement | |||
Image:LAE.png| Left atrial enlargement with ECG. | |||
Image:LAE-v1.png| Left atrial enlargement as seen in lead V1. | |||
Image:LAE_12lead.jpg| Left atrial enlargement as seen on a 12 lead ECG | |||
</gallery> | |||
</div> | |||
;Criteria for left atrial voor left atrial enlargement. Either | ;Criteria for left atrial voor left atrial enlargement. Either | ||
:P wave with a broad (>0,04 sec or 1 small square) and deeply negative (>1 mm) terminal part in V1 | :P wave with a broad (>0,04 sec or 1 small square) and deeply negative (>1 mm) terminal part in V1 | ||
:P wave duration >0,12 sec in laeds I and / or II | :P wave duration >0,12 sec in laeds I and / or II | ||
Left atrial enlargement is often seen in mitral valve insufficiency, resulting in backflow of blood from the left ventricle to the left atrium and subsequent incresed local pressure. | Left atrial enlargement is often seen in mitral valve insufficiency, resulting in backflow of blood from the left ventricle to the left atrium and subsequent incresed local pressure. | ||
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==Right atrial enlargement== | ==Right atrial enlargement== | ||
<div style="float:right;margin-left:10px"> | |||
<gallery> | |||
Image:right_atrial_enlargement.jpg|Right atrial enlargement | |||
Image:RAE.png|Right atrial enlargement | |||
</gallery> | |||
</div> | |||
;Right atrial enlargement is defined as either: | ;Right atrial enlargement is defined as either: | ||
:P >2,5 mm in II / III and / or aVF | :P >2,5 mm in II / III and / or aVF | ||
:P >1,5 mm in V1. | :P >1,5 mm in V1. | ||
Right atrial enlargement can result from increased pressure in the pulmonary artery, e.g. after pulmonary embolisation. A positive part of the biphasic p-wave in lead V1 larger than the negative part indicates right atrial enlargement. The width of the p wave does not change. | Right atrial enlargement can result from increased pressure in the pulmonary artery, e.g. after pulmonary embolisation. A positive part of the biphasic p-wave in lead V1 larger than the negative part indicates right atrial enlargement. The width of the p wave does not change. | ||
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In biatrial enlargement is the ECG whos signs of both left and right atrial enlargement. In V1 the p wave has large peaks first in positive and later in negative direction. | In biatrial enlargement is the ECG whos signs of both left and right atrial enlargement. In V1 the p wave has large peaks first in positive and later in negative direction. | ||
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==References== | ==References== | ||
<biblio> | <biblio> | ||
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#Sundstrom pmid=7923663 | #Sundstrom pmid=7923663 | ||
</biblio> | </biblio> | ||
}} | |||
[[Category:ECG Textbook]] | |||