Download - ECG: Congenital Heart Disease
ECG OF THE WEEK
Prof.VIJAYARAGHAVAN‘S UNITB.Elavazhagan.
A 20 YEAR OLD MALE, A KNOWN CASE OF CHD PRESENTED TO THE opd.
ECG
ECG
SUMMARY OF THE FINDINGS Rate – 120/min Sinus rhythm Tall peaked P wave in lead 2 Predominantely positive P wave in V1 PR interval- 0.16 s, QRS Complex –0.12 s, ST ,T normal; Extreme right axis
CONTD………. QRS configuration – V1 shows RS complex; abrupt change to rS in V2; leads V3-V6 shows rS complexes aVR shows qR complex.
Lead 1 shows deep S wave
Lead 2 & 3 shows S waves
INFERENCE
Right ventricular enlargement Right atrial enlargement Right axis deviationS 1 S 2 S 3 pattern
CRITERIA FOR RVH SOKOLOW LYON CRITERIA : R V1 + S V5/V6 > 1.1 mv
BUTLER LEGGET CRITERIA : Tallest R /R’ in V1 + deepest S wave in LEAD 1 /V6 – s wave in V1 > 0.7 mv
OTHER FEATURES; -RIGHT AXIS DEVIATION ,CLOCKWISE ROTATION -RBBB PATTERN ,R: S > 1 IN V1 ,R /R ‘ > 5 mm P WAVE AXIS > 60 DEG – ACQUIRED HEART
DISEASE UPTO 60 DEG –CONGENITAL HEART
DISEASE
DIFFERENTIAL DIAGNOSIS FOR S1 S2 S3 PATTERN WITH RVH COPD –P axis > 70 ; low voltage QRS in
precordial leads
Endocardial cushion defects –QRS north west axis
LAHB deep S in lead 2 >
lead 3;
VSD with PHT –LVH with RVH right axis deviation;
Complete TGA – av block and other heart blocks ;
CONTD………. Isolated pulmonary stenosis /atresia—
RVH with S1 S2 S3 pattern but deep T
wave inversion present in addition
Triology of fallot – LAE ,widening of P wave
Tetrology of fallot – - RVH , RAE , S1 S2 S3 PATTERN , right axis deviation around 120 – 150 degrees -Rs pattern in V1 abrupt change to rS V2
and subsequent leads T inversion may be seen in V1 ,but not in
others
DIAGNOSISSince the ecg of our patient has1.RAE2.RVH3.RIGHT AXIS DEVIATION4.S1 S2 S3 PATTERN5.CLOCK WISE ROTATION THE DIAGNOSIS IS “TOF”
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