miscellaneous ekg changes chapter 14 robert j. huszar, md instructor patricia l. thomas, mba, rcis
TRANSCRIPT
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Miscellaneous EKG Changes Chapter 14
Robert J. Huszar, MD
Instructor
Patricia L. Thomas, MBA, RCIS
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Outline• Chamber Enlargement• Right Atrial Enlargement• Left Atrial Enlargement• Right Ventricular Enlargement• Left Ventricular Enlargement• Pericarditis• Electrolyte Imbalance• Drug Effect• Pulmonary Disease• Early Repolarization• Hypothermia• Preexcitation Syndromes
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Chamber EnlargementDilatation vs. Hypertrophy
• Dilatation is the distension of an individual heart chamber, it may be acute or chronic.
• Hypertrophy is a chronic condition of the heart characterized by an increase in the thickness of a chamber’s myocardial wall secondary to the increase in the size of the muscle fibers.
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Right Atrial Enlargement(dilatation & hypertrophy)
• Increase pressure/volume results in overload in the RA.
• ECG Characteristics– Duration: P wave .10 or <– Shape: Tall/peaked in Leads II,III &
aVF, biphasic in V1 & V2– Direction: Positive– Amplitude: 2.5mm or >– Causes PS,TS, TI, Pulmonary
Hypertension
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Left Atrial Enlargement(dilatation/hypertrophy)
• Increase pressure/volume results in overload in the LA.
• ECG Characteristics– Duration: P wave >.12 – Shape: Broad positive upright, wide
notched (two humps), biphasic
– Direction: Positive Leads I,II & V4-V6– Amplitude: normal .5-2.5mm– Causes: MS, acute MI, LHF, AS or AI,
HCOP
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Right Ventricular Hypertrophy• Increase pressure/volume results in overload in the
RV.• ECG Characteristics
– Duration: QRS .10 or < – QRS Axis: RAD +90 0 or < – VAT: prolonged = .035 sec in V1 & V2– QRS Pattern: q waves leads II,III & aVF– R waves: = or > S waves in Lead V1– ST segment: Downsloping of 1mm or >– Hockey stick: ST depression & T-wave inversion– T wave: inversion in II, III, aVF & V1,V2 & V3– Causes: MS, acute MI, COPD
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Left Ventricular Hypertrophy
• Increase pressure/volume results in overload in the LV.
• ECG Characteristics– Duration: QRS .10 or < – QRS Axis: LAD >-30 0 – VAT: prolonged = .04 sec in V5 & V6– QRS Pattern: R waves leads II,III & aVF– R waves: Tall 20 mm or > wave in Lead I, > 30
mm in Leads V5 & V6– S wave: Deep in Lead III, V1 & V2
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Left Ventricular Hypertrophycont…
• ECG Characteristics cont..– Sum of R/S: Any R wave and S wave > 20
mm & Sum of S wave in V1 or V2 and R wave in Lead V5 or V6 is 35 mm or> .
– ST segment: Downsloping ST depression of 1m or > in Leads I, aVL & V5, V6
– T wave: Inversion in I, aVL & V5, V6