EKG Review

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Author:
NavyArmy
ID:
298675
Filename:
EKG Review
Updated:
2015-03-18 17:55:46
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EKG
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EKG review
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  1. How to diagnose right atrial enlargement.
    Look at leads II and V1

    Right atrial enlargement is characterized by the following:

    1. P waves with an amplitude exceeding 2.5 mm in the inferior leads.

    2. No change in the duration of the P wave.

    • 3. Possible right axis deviation of the P wave beyond normal axis of:
    •    ⇒ 0° to 70° (adults)
    •    ⇒ 0° to 90° (children)
  2. How to diagnose left atrial enlargement.
    Look at leads II and V1

    Left atrial enlargement is characterized by the following:

    1.  The amplitude of the terminal (negative) component of the P wave may be increased and must descend at least 1 mm below the isoelectric line in lead V1.



    2.  The duration of the P wave is increased, and the terminal (negative) portion of the P wave must be at least 1 small block (0.04 second) in width.

    3. No significant axis deviation is seen because the left atrium is normally electrically dominant.
  3. EKG criteria for diagnosing R ventricular hypertrophy.
    Note: QRS axis must exceed +100°

    Look at precordial leads V1 - V5:

    1.  In lead V1, the R wave is larger than the S wave.

    2.  In lead V6, the S wave is larger than the R wave.
  4. What are the most common causes of R ventricular hypertrophy?
    COPD and congenital heart disease.
  5. EKG criteria (precordial leads) for L ventricular hypertrophy.
    L axis deviation beyond -15° s often seen.

    Increased R wave amplitude in those leads overlying the L ventricle forms the basis for the EKG diagnosis of LVH.

    Common theme: increased R wave amplitude in leads overlying the L ventricle and increased S wave amplitude in leads overlying the R ventricle.

    ** Look at the precordial leads (more sensitive than limb leads for dx of LVH):

    1.  R wave in lead V5 or V6 plus the S wave in lead V1 or V2 > 35 mm.

    2.  R wave in lead V5 > 26 mm.

    3.  R wave in lead V6 > 18 mm.

    4.  R wave in lead V6 > R wave in lead V5.

    Note:

    • - first criteria has most predictive value
    • - These criteria have little value in those < 35 years of age (increased voltage due to thin chest walls)
    • - Unreliable in young children.
  6. EKG criteria (limb leads) for L ventricular hypertrophy.
    ** Look at the limb leads (more sensitive than limb leads for dx of LVH):

    1.  R wave in aVL exceeds 13 mm.

    2.  R wave in aVF exceeds 21 mm.

    3.  R wave in lead I exceeds 14 mm.

    4.  R wave in lead I plus S wave in lead III exceeds 25 mm.

    Note: the first criteria has excellent specificity for LVH, although not sensitive.
  7. What are the leading causes of LVH?
    Systemic HTN and valvular disease.

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