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Atrial and Ventricular Hypertrophy.

Atrial and Ventricular Hypertrophy. ECG Features and Common Causes. Aims and Objectives. Understand pathophysiology of types of hypertrophy. Common patient presentation and symptoms. ECG appearances associated with different types of hypertrophy. Pitfalls in diagnosis from ECG.

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Atrial and Ventricular Hypertrophy.

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  1. Atrial and Ventricular Hypertrophy. ECG Features and Common Causes.

  2. Aims and Objectives. • Understand pathophysiology of types of hypertrophy. • Common patient presentation and symptoms. • ECG appearances associated with different types of hypertrophy. • Pitfalls in diagnosis from ECG.

  3. Left Atrial Hypertrophy / Enlargement. Thickening of wall. Dilatation of chamber (enlargement). Increased volume. Increased muscle mass.

  4. Some causes. Mitral and / or aortic valve disease. Left ventricular systolic and diastolic dysfunction. Cardiomyopathy - hypertrophic / dilated. Atrial fibrillation. Left atrial mass. Hypertension.

  5. ECG appearances.

  6. Appearances cont..

  7. Common ECG Features of LAH. • Usually seen in late portion of P wave. • Often biphasic in V1 - larger negative deflection. • RA conducts anteriorly (+ initially) • Large LA mass conducts posteriorly (-ive component). • Prolonged P wave duration (>0.12 secs). • Pronounced notch with peak to peak >0.04secs.

  8. Right Atrial Hypertrophy / Enlargement.

  9. Some causes. Tricuspid and / or pulmonary valve disease. Lung disease. Congenital heart disease (ASD, PFO, VSD). RV systolic and diastolic dysfunction. Mitral stenosis (pressure back-up).

  10. RAH Appearance.

  11. Common ECG Appearance. Tall, peaked P wave (>2.5mm). Best seen lead II - often throughout ECG. Known as P pulmonale.

  12. Left Ventricular Hypertrophy. Thickened walls. Dilated chamber. Increased muscle mass or increased volume.

  13. Some causes of LVH. Aortic valve disease. Coarctation of the aorta. Cardiomyopathy - dilated, hypertrophic. Hypertension. Heart Failure - systolic.

  14. Left Ventricular Hypertrophy Appearance.

  15. LVH Appearance.

  16. Commonly Used Criteria for LVH. Scoring System. Suggested if >5 points. Chou, T. and Knilans, T.K. (1996). Electrocardiography in Clinical Practise. 4th Ed. Philadelphia: Saunders. • ECG Feature: • Amplitude: • Largest R or S wave in limb leads >20mm. • S wave leads V1 and V2 >30mm. • R waves in leads V5 or V6 >30mm. 3 POINTS. ST-T wave changes typical for LVH. 3 POINTS. Left atrial involvement. 3 POINTS. Left axis deviation. 2 POINTS. QRS Duration of >0.09s. 1 POINT.

  17. Right Ventricular Hypertrophy.

  18. Some causes of RVH. Pulmonary hypertension (numerous causes - primary and secondary - also cor pulmonale). Mitral stenosis. Pulmonary valve disease. Congenital heart disease (VSD, Ebsteins Anomaly). RV systolic dysfunction (e.g. post inferior MI).

  19. ECG Appearance Right Ventricular Hypertrophy.

  20. ECG Criteria for RVH. • Right axis deviation of +110 degrees or more. • Dominant R wave in lead V1. • R wave in lead V1 >7mm. • Other supporting criteria: • ST segment depression and T inversion V1 - V4. • Deep S waves V5, V6, I and aVL.

  21. Conclusion. • LAH – ECG appearance and common causes. • RAH – appearance and causes. • LVH – appearance, certainty of diagnosis, causes and pitfalls. • RVH – appearance, causes and pitfalls.

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