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Ventricular Enlargement and Hypertrophy

Objectives: LVH RVH PE EKG of LVH Several EKG criteria have been used in the diagnosis of LVH. These include: CHANGES IN THE PRECORDIAL LEADS Abnormalities in the QRS complex Increased amplitude or voltage of the QRS complex Limb leads R wave in any limb lead measuring ≥20 mm S wave in any limb lead measuring  ≥20 mm R wave in aVL >11 mm R in lead I +S in III  >25 mm Precordial leads S wave in V1 or V2 ≥30 mm R wave in V5 or V6 ≥30 mm R wave in V5 or V6 >26 mm S wave in V1, V2 or V3 ≥25 mm R wave in V4, V5 or V6 ≥25 mm SV1 + RV5 or V6 > 35 mm Tallest S + tallest R in V1 to V6 >45 mm R wave in V6 > R wave in V5 Limb + Precordial leads R wave in aVL + S wave in V3 >20 mm in females R wave in aVL + S wave in V3  >28 mm in males Total QRS voltage from all 12 ECG leads >175 mm Increased duration of the QRS complex Delayed onset of intrinsicoid deflection ≥ 0.05 seconds in V5 or V6 Increased duration of the QRS complex ≥ 0.09 seconds Abnormalities in the ST segment...
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Cardiac Rotation/ R Wave Progression

  Objectives: Horizontal Plane/ Precordial Leads Cardiac Rotation: 2 types Clockwise/ delayed transition Anticlockwise/ early transition Examples: Tall R waves in lead V1 clockwise rotation The Horizontal Plane/ Precordial Leads The six precordial leads V1 to V6 are also called horizontal or transverse leads since they represent the horizontal or transverse plane of the chest. The horizontal plane includes the left/right as well as the anteroposterior sides of the chest Leads V1 and V2: Leads V1 and V2 are right-sided precordial leads and are positioned directly over the right ventricle. The QRS complexes in V1 and V2 represent electrical forces generated from the right ventricle and generally show small r and deep S waves. Leads V5 and V6: Leads V5 and V6 are left-sided precordial leads that directly overlie the left ventricle. The QRS complexes represent electrical forces generated from the left ventricle, which show small q waves followed by tall R waves. Leads V3 and V4: The ...
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Determining the Cardiac Axis of Heart

  Objectives: The frontal plane and the Hexaxial Reference System Basic considerations Method 1: Figuring Out the Electrical Axis when an Equiphasic Complex is Present Method 2: Figuring Out the Electrical Axis when an Equiphasic Complex is NOT Present
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