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ECG: Congenital Heart Disease

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  • 1. ECG OF THE WEEK
    Prof.VIJAYARAGHAVAN‘S UNIT
    B.Elavazhagan.
  • 2. A 20 YEAR OLD MALE, A KNOWN CASE OF CHD PRESENTED TO THE opd.
  • 3. ECG
  • 4.
  • 5. ECG
  • 6. 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
  • 7. 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
  • 8. INFERENCE
    Right ventricular enlargement
    Right atrial enlargement
    Right axis deviation
    S 1 S 2 S 3 pattern
  • 9. 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
  • 10. 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 ;
  • 11. 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
  • 12. diagnosis
    Since the ecg of our patient has
    1.RAE
    2.RVH
    3.RIGHT AXIS DEVIATION
    4.S1 S2 S3 PATTERN
    5.CLOCK WISE ROTATION
    THE DIAGNOSIS IS
    “TOF”
  • 13. Thank you