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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===Examples===
===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
[[Image:left_atrial_enlargement.jpg|thumb| Left atrial enlargement]]
[[Image:LAE.png|thumb| Left atrial enlargement with ECG.]]
[[Image:LAE-v1.png|thumb| Left atrial enlargement as seen in lead V1.]]
[[Image:LAE_12lead.jpg|thumb| Left atrial enlargement as seen on a 12 lead ECG]]
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.
[[Image:right_atrial_enlargement.jpg|thumb|  Right atrial enlargement]]
[[Image:RAE.png|thumb| Right atrial enlargement]]
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]]
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