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Ecg in av enlargement
- 1. ECG Changes in atrioventricular enlargement Prepared by, Jesna Krishnan CON, ACME, Pariyaram
- 2. CHAMBER ENLARGEMENT • Enlargement of atria or ventricle or both. • It implies dilation or hypertrophy. • Dilation implies an increase in internal diameter of cardiac chamber due to volume overload. • Hypertrophy occurs due to pressure or systolic overload or both.
- 3. ATRIAL ENLARGEMENT • Left atrial, right atrial, biatrial enlargement • In 12 lead ecg it is characterized by changes in the P wave duration and morphology.
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- 6. Atrial Enlargement/Hypertrophy • Etiology: – Valvular heart disease – Congenital heart disease – Atrial hypertrophy secondary to ventricular hypertrophy – Pulmonary hypertrophy and PAH
- 7. ECG Criteria in atrial hypertrophy • Expressed in P wave abnormalities
- 8. ECG Criteria in atrial hypertrophy Normal P wave characteristics: • Pyramidal in shape with rounded apex • Always positive in lead II and negative in aVR • Duration:0.08 sec to 0.10sec • Height and width: < 2.5 mm • P wave axis is +45 to +65 clockwise. • >65 indicates Rt. axis deviation • <45 indicates Lt. Axis deviation
- 9. ATRIAL ENLARGEMENT • P wave abnormalities: Rt. atrial enlargement/ hypertrophy: • Increases the height of the P wave Lt. atrial enlargement : • Widens the P wave
- 10. RIGHT ATRIAL ENLARGEMENT • Increase in muscle mass cause delay in conduction. • Reflected as increased voltage of P wave • It produces rotational effect which is reflected in QRS abnormalities.
- 11. RIGHT ATRIAL ENLARGEMENT • ECG changes of rt atrial hypertrophy is divided in to 2: 1. Direct Reflected by one or more of the following manifestations. • Tall P wave with rt axis deviation :- P pulmonalae: Seen in leads II, III, aVF
- 12. • Abnormalities in P wave axis – Directed towards rt axis +70 to +90 – Up right deflection of biphasic P wave in lead II or V1. – Early negative deflection of P wave in lead V1
- 17. 2. Indirect: 2 characteristic feature of QRS Complex suggest rt. Atrial enlargement. – QR complex in lead V1 – Diminution in height of QRS complex in lead V1 with marked increase in its height in lead V2
- 18. • Twave inversion in lead v1-v2 and sometimes v3 and v4 • Deep s waves in lead v6
- 26. Ventricular enlargement • Left Ventricular, right ventricular, biventricular enlargement • In 12 lead ecg it is characterized by changes in the QRS complex
- 28. Basic ECG presentation of RVH • Right axis deviation is the commonest and at times only presentation usually directed from +90 to +180 degree. • Such right axis deviation is usually an expression of free Right wall hypertrophy.
- 33. ST Segment and T Wave • When RV under strain due to increased right ventricular pressure the T wave vector is directed away from the right resulting in T wave inversion in right oriented leads. • T wave inversion is most marked in V1 and V2 • With severe compromised RV the inverted T wave may be very deep, symmetrical, pointed and tend to ischemic type. • ST Segment is minimally depressed and slightly convex upwards.