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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)
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.
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.
What are the most common causes of R ventricular hypertrophy?
COPD and congenital heart disease.
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.
- - 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.
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.
What are the leading causes of LVH?
Systemic HTN and valvular disease.
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