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ECG& CHDs.pdf
- 4. First step Suspicionof CHDs Nada’s criteria 2nd step SP O2 Acyanotic / cyanotic CHDs 3rd step 4th step CVS examination X ray Chest PA View
- 5.
- 6. ▪ ECG isa simple .and useful bedside investigation which helps in the diagnosis and management of patients with CHDs. ▪ In specific setting ECG can give specific diagnostic informations. E. C. G.
- 7. E. C. G. ▪ECG reflects the underlying structural and hemodynamic changes that occur in the disease state. Hence a number of conditions with similar profiles may have similar ECG patterns.
- 8. At glance youmay feel all E.C.G. look alike. Look Closely and you will see the differences!
- 9. How to diagnoseCHDs by ECG ?
- 10. Acyanotic CHD LEFT TORIGHT SHUNT ECG in lead V4R,V1 if depicts RSR, rSR’, rsr, RsR (volume over load) Suggest Left to Right shunt is at Atrial level PRETRICUSPID Normal or Right axis deviation suggest A.S.D. Partial anomalous pulmonary venous drainage (PAPVD) Ejection systolic murmur in pulmonary area; Loud and wide splitting of S2 Parasternal Pansystolic murmur continuous (Machinery ) murmur Suggest Left to Right shunt after Atrial level POSTRICUSPID SHUNT V.S.D. P.D.A.
- 11. Acyanotic CHD LEFT TORIGHT SHUNT ECG in lead V4R,V1 if depicts RSR, rSR’, rsr, RsR (volume over load) Suggest Left to Right shunt is at Atrial level PRETRICUSPID Normal or Right axis deviation suggest A.S.D. Partial anomalous pulmonary venous drainage (PAPVD) Ejection systolic murmur in pulmonary area; Loud and wide splitting of S2
- 12. Left axis deviation- 30 t0 -60᷁ suggest A.S.D. Primum defect
- 13. LEFT TO RIGHT SHUNT Leftaxis deviation > -60᷁ suggest Complete atrio-ventricular canal defect
- 14. LEFT TO RIGHT SHUNT Leftaxis deviation > -60᷁ suggest Complete atrio-ventricular canal defect Associated RightVentricular Hypertrophy suggest Lesion is associated with Pulmonary arterial hypertension(PAH) Or Pulmonary stenosis Associated leftVentricular Hypertrophy suggest Lesion is associated with Mitral regurgitation Rupture of sinus of valsalva into right atrium Shunt from left ventricle to right atrium
- 15. Suggest Left toRight shunt is after Atrial level POSTRICUSPID SHUNT V.S.D. P.D.A. Parasternal Pansystolic murmur or continuous (Machinery ) murmur E.C.G. finding depends upon size of shunt, small shunt normal E.C.G.; Large shunt associated with LVH or BVH. E.C.G. is very useful in follow up – progressive development RVH suggest PAH or PS Progressive increase in LVH suggest aortic regurgitation Acyanotic CHD LEFT TO RIGHT SHUNT
- 16. E.C.G. DEPICTS “RAD”WITH“ RVH” IN VALVULAR PULMONARY STENOSIS Pure “R” wave inV1 with inverted “T” indicate severe PS Upright “T” inV3R indicate obstructive muscle bundle in Rv RVSP = 5 X magnitude of “R” mmin v1 or rv4 in mmHg RVSP = “R” mm X 3 + 47 in mm Hg E.C.G. finding depends upon size of shunt, small shunt normal E.C.G.; Large shunt associated with LVH or BVH. E.C.G. is very useful in follow up – progressive development RVH suggest PAH or PS Progressive increase in LVH suggest aortic regurgitation Acyanotic CHD Obstructive CHDs
- 17. One must decidenature CHDs CHDs Acyanotic CHD’s Cyanotic CHD’s
- 18. Abnormal quadrant QRSaxis - Double outlet right ventricle Cyanotic CHD
- 19. Left axis deviationwith left ventricular hypertrophy - tricuspid atresia Cyanotic CHD
- 20. Monomorphic QRS complexin chest leads - single ventricle RADWITH RVH OR LADWITH RVH Left axis deviation with left ventricular hypertrophy - tricuspid atresia Cyanotic CHD d –T.G.A. - cyanosis with typical X – ray chest RADWITH RVH suggest dT.G.A. With outV.S.D. RADWITH BVH suggest dT.G.A. WithV.S.D.
- 21. Ebstein ‘s anomaly:Tall “Himalayan” P waves, prolonged RR intervale & QRS – RBBB Type “B”WPW syndrome (right side kent bundle) PSVT, Atrial flutter or fibrilation (1/3) Anomalous left coronary artery from pulmonary artery (ALCAPA) Deep “q” wave in lead I, aVl, and v4 –v6 with elevation of ST segment and “T” wave inversion. Pompes’ disease – Short PR intervale LAD with LVH (huge QRS) Other CHD Corrected -T.G.A. - Absent “q” wave in lead I & aVL and present in right sided leads III & aVF. Positive “T” wave in all chest leads Prolonged PR interval; PVST;Type AWPW syndrome
- 22. Ebstein ‘s anomaly:Tall “Himalayan” P waves, prolonged RR intervale & QRS – RBBB Type “B”WPW syndrome (right side kent bundle) PSVT, Atrial flutter or fibrilation (1/3) Anomalous left coronary artery from pulmonary artery (ALCAPA) Deep “q” wave in lead I, aVl, and v4 –v6 with elevation of ST segment and “T” wave inversion. Pompes’ disease – Short PR intervale LAD with LVH (huge QRS) Other CHD Corrected -T.G.A. - Absent “q” wave in lead I & aVL and present in right sided leads III & aVF. Positive “T” wave in all chest leads Prolonged PR interval; PVST;Type AWPW syndrome
- 23. Ebstein ‘s anomaly:Tall “Himalayan” P waves, prolonged RR intervale & QRS – RBBB Type “B”WPW syndrome (right side kent bundle) PSVT, Atrial flutter or fibrilation (1/3) Anomalous left coronary artery from pulmonary artery (ALCAPA) Deep “q” wave in lead I, aVl, and v4 –v6 with elevation of ST segment and “T” wave inversion. Pompes’ disease – Short PR intervale LAD with LVH (huge QRS) Other CHD Corrected -T.G.A. - Absent “q” wave in lead I & aVL and present in right sided leads III & aVF. Positive “T” wave in all chest leads Prolonged PR interval; PVST;Type AWPW syndrome
- 24. Ebstein ‘s anomaly:Tall “Himalayan” P waves, prolonged RR intervale & QRS – RBBB Type “B”WPW syndrome (right side kent bundle) PSVT, Atrial flutter or fibrilation (1/3) Anomalous left coronary artery from pulmonary artery (ALCAPA) Deep “q” wave in lead I, aVl, and v4 –v6 with elevation of ST segment and “T” wave inversion. Pompes’ disease – Short PR intervale LAD with LVH (huge QRS) Other CHD Corrected -T.G.A. - Absent “q” wave in lead I & aVL and present in right sided leads III & aVF. Positive “T” wave in all chest leads Prolonged PR interval; PVST;Type AWPW syndrome
- 25. Dextro-cardia Negative “P” wavein lead I & aVL Positive “P” in lead aVR “Q” wave inV4R,V6R and aVR Diminishing voltage of QRS from V1 toV6 Other CHD
- 26. CHDs Asymptomatic Symptomatic Retarction,, hepatomegaly,CHF Absent Femoral pulse Coarctation Aorta Normal femoral LoudS2 Insignificant murmur V.S.D. P.D.A. Normal s2 No Murmur DILATED CARDIOMYOPATHY HSM - Ebstein’s SEM- Aortic stenosis Ejection systolic murmur HSM LS B V.S.D. APEX MR Wide split S2 - ASD Normal S2 ➢Radiating to carotid aortic stenosis ➢Radiating to axills Pulmonary stenosis
- 27. Acyanotic CHD LEFT TORIGHT SHUNT ECG in lead V4R,V1 if depicts RSR, rSR’, rsr, RsR (volume over load) Suggest Left to Right shunt is at Atrial level PRETRICUSPID Normal or Right axis deviation suggest A.S.D. Partial anomalous pulmonary venous drainage (PAPVD) Ejection systolic murmur in pulmonary area; Loud and wide splitting of S2 Parasternal Pansystolic murmur continuous (Machinery ) murmur Suggest Left to Right shunt after Atrial level POSTRICUSPID SHUNT V.S.D. P.D.A.
- 28. ECG is animportant tool in assessment of CHDs ELECTROCARDIOGRAM Which ventricle is dominant ? Right ventricular dominance - RAD & RVH It indicate either right heart disease and takes the form of RAD along with right atrial and right ventricular hypertrophy or hypoplastic left heart syndrome. left ventricular dominance – LAD & LVH It indicate either left heart disease and takes the form of LAD along with left atrial and left ventricular hypertrophy or hypoplastic right heart syndrome
- 29. ELECTROCARDIOGRAM I degree heartblock - Endocardial septal defect Corrected - l-T.G.A. Ebstein’s anomaly The ARRHYTHMIA and CHDs Complete A-V Block - Corrected – l -T.G.A, Hetrotaxy S.L.E. .Paraoxysmal - WPW SYNDROME Supraventricular Ebstein’s anomaly tachycardia .