Atrial and Ventricular Hypertrophy.

ECG Features and Common Causes.

Aims and Objectives.

 Understand pathophysiology of types of hypertrophy.

 Common patient presentation and symptoms.

 ECG appearances associated with different types of hypertrophy.

 Pitfalls in diagnosis from ECG.

Left Atrial Hypertrophy / Enlargement.

  Thickening of wall.

Dilatation of chamber (enlargement).

  Increased volume.

Increased muscle mass.

Some causes.

      Mitral and / or aortic valve disease.

Left ventricular systolic and diastolic dysfunction.

Cardiomyopathy - hypertrophic / dilated.

Atrial fibrillation.

Left atrial mass.

Hypertension.

ECG appearances.

Appearances cont..

Common ECG Features of LAH.

  Usually seen in late portion of P wave.

Often biphasic in V1 - larger negative deflection.

– RA conducts anteriorly (+ initially) – Large LA mass conducts posteriorly (-ive component).

• Prolonged P wave duration (>0.12 secs).

• Pronounced notch with peak to peak >0.04secs.

Right Atrial Hypertrophy / Enlargement.

Some causes.

     Tricuspid and / or pulmonary valve disease.

Lung disease.

Congenital heart disease (ASD, PFO, VSD).

RV systolic and diastolic dysfunction.

Mitral stenosis (pressure back-up).

RAH Appearance.

Common ECG Appearance.

   Tall, peaked P wave (>2.5mm).

Best seen lead II - often throughout ECG.

Known as P pulmonale.

Left Ventricular Hypertrophy.

   Thickened walls.

Dilated chamber.

Increased muscle mass or increased volume.

Some causes of LVH.

     Aortic valve disease.

Coarctation of the aorta.

Cardiomyopathy - dilated, hypertrophic.

Hypertension.

Heart Failure - systolic.

Left Ventricular Hypertrophy Appearance.

LVH Appearance.

Commonly Used Criteria for LVH.

   Scoring System.

Suggested if >5 points.

Chou, T. and Knilans, T.K. (1996).

Electrocardiography in Clinical Practise

.

4th Ed

. Philadelphia: Saunders.

  ECG Feature: Amplitude: – Largest R or S wave in limb leads >20mm.

– S wave leads V1 and V2 >30mm.

– R waves in leads V5 or V6 >30mm.

3 POINTS.

ST-T wave changes typical for LVH.

3 POINTS.

Left atrial involvement.

3 POINTS.

Left axis deviation.

2 POINTS.

QRS Duration of >0.09s.

1 POINT.

Right Ventricular Hypertrophy.

Some causes of RVH.

 Pulmonary hypertension (numerous causes - primary and secondary - also cor pulmonale).

   Mitral stenosis.

Pulmonary valve disease.

 Congenital heart disease (VSD, Ebsteins Anomaly). RV systolic dysfunction (e.g. post inferior MI).

ECG Appearance Right Ventricular Hypertrophy.

ECG Criteria for RVH.

 Right axis deviation of +110 degrees or more.

  Dominant R wave in lead V1.

R wave in lead V1 >7mm.

 Other supporting criteria: – ST segment depression and T inversion V1 V4.

– Deep S waves V5, V6, I and aVL.

Conclusion.

    LAH – ECG appearance and common causes.

RAH – appearance and causes.

LVH – appearance, certainty of diagnosis, causes and pitfalls.

RVH – appearance, causes and pitfalls.