tall initial upstroke of P wave in V1 and a terminal neg deflection - ANS right atrial enlargement criteria
right atrial enlargement - ANS Also known as p pulmonale because it can be caused by severe lung
disease. Causes include pulmonary HTN, chronic lung disease, tricuspid stenosis and congenital heart
disease (pulmonic stenosis, atrial septal defect, Ebsteins anomaly, tetralogy of Fallot).
Ebstein's anomaly and right atrial enlargement - ANS This is a rare, congenital (present at birth) heart
defect. In patients with this, the valve between the chambers on the right side of the heart (the tricuspid
valve) does not close correctly. What is this? And what other cardiac diagnosis would you have with it?
tetralogy of fallot
1. Large, over-riding aorta
2. Malalignment VSD
3. Pulmonary Stenosis
4. Right Ventricular Hypertrophy - ANS This is the most common cyanotic congenital heart defect to
survive beyond infancy. This is one of the causes of right atrial enlargement.
What is this? And what are the factors that associate with it?
Notched or "M" shaped P wave in leads II & V1 (p mitrale)
P wave width: >0.12 seconds
Small initial upstroke of P wave in V1 w/deep terminal negative deflection - ANS What criteria must you
meet on an ECG to be defined as left atrial enlargement?
,left atrial enlargement - ANS ______ is also known as p mitrale because the condition is classically seen
with mitral stenosis.
Hypertensive Heart Disease (LAE & L. ventricle hypertrophy)
Cardiomyopathies
CAD - ANS What are some causes of left atrial enlargement?
right ventricular hypertrophy - ANS Abnormal thickening of the right ventricle leads to changes in the
QRS complex as a result of increase electrical dominance. A large R wave is produced in lead V1 and
large S wave in lead V5 or V6. What does this describe?
Pulmonary HTN
Mitral Stenosis
Pulmonary Embolism
Congenital Heart Disease (pulmonic stenosis, atrial septal defect with R->L shunting called
Eisenmenger's syndrome and tetralogy of Fallot) - ANS What are some main causes of right ventricular
hypertrophy?
Right axis deviation (of +110 degree or more)
R wave in V1 exceeds depth of S wave
RV strain pattern (T wave inversions w/possible ST depression in V1 & V2)
Reversed R wave progression in V1-V6 - ANS What criteria must be met on an ECG to diagnose a right
ventricular hypertrophy?
left ventricular hypertrophy - ANS ______ is described as when the left side of the heart wall is very
thick, which exaggerates the deflection of the QRS complex in the chest leads.
,HTN (most common)
Aortic stenosis
Aortic regurgitation (aka aortic insufficiency)
Mitral regurgitation (aka mitral insufficiency)
Coarctation of aorta
Hypertrophic cardiomyopathy - ANS What are the causes of left ventricular HTN?
Right bundle branch block - ANS This is present when depolarization of the right ventricle occurs slightly
later than depolarization of the left ventricle. The asynchronous depolarization of the ventricles
produces a characteristic change in the shape of the QRS complex, best seen in leads V1 & V2. The
complexes appear superimposed over one another, creating a wide QRS fusion complex that has two R
waves (two peaks). "rabbit ear" or "M" pattern on ECG. Can also produce wide, slurred S waves in lateral
leads (V5, V6, I & aVL)
left bundle branch - ANS Which bundle branch block is more often associated with an underlying heart
disease?
Also, may occur during insertion of pulmonary artery cath - ANS Causes of right bundle branch blocks
left bundle branch block - ANS Appearance of QRS complex is affected- broad notched top or slurred R
wave. Best seen in I, aVL, V5 & V6.
, V1, V2 and V3: reciprocal changes seen w/broad, deep S waves.
Direction of depolarization from right to left--> left axis deviation
Almost always sign of organic heart disease
Long standing HTN heart disease
Valvular heart disease
CAD (esp anterior wall ischemia/infarction)
Cardiomyopathies
LVH
Degenerative changes - ANS Causes of left bundle branch blocks
I ischemia & injury (CVA, SAH)
N normal variant (esp in young pts)
V ventricular hypertrophy
E ectopic foci (i.e., calcified plaque)
R right & left BBB
T treatments (i.e., digitalis) - ANS Causes of T wave inversion
D Drooping of mitral valve (prolapse)
E Enlargement of LV with strain pattern
P Potassium loss (hypokalemia)
R Reciprocal ST depression in AMI
E Embolism in lungs (pulmonary embolism)
S Subendocardial ischemia
S Subendocardial infarct
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