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ECG of the Enlarged Heart. The Cardiac Cycle. Know this. During examination V follows S2 and should be Visible with elevated JVP. Mitral Regurg. Aortic Regurg. Mitral Stenosis. Aortic Stenosis. What are the features of this ECG. Relations of ECG leads. aVR RV. - PowerPoint PPT Presentation
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ECG of the Enlarged Heart
The Cardiac Cycle
Know this
During examinationV follows S2 and should beVisible with elevated JVP
Mitral Regurg
Aortic Regurg
Mitral Stenosis
Aortic Stenosis
What are the features of this ECG
Relations of ECG leads
aVRRV
Characteristics of normal QRS complex
1. Width : 3 small squares or less2. In Lead V1, the depth of S wave is > than the
height of R wave3. In Lead V5,V6, the height of R wave is always
< 25mm4. In the left ventricular leads (V5, V6), presence
of a septal Q wave is normal
Features of Left Ventricular Hypertrophy
• Left axis deviation (look at inferior leads III or AVF)• Tall R waves in lateral LV leads (aVL, V, VI - but not
V/VI in a grossly enlarged heart)• Deep S in septal/RV leads
(III, V1 & V2)• Delayed intrinsicoid deflection
> 0.05s• Strain pattern• ST-T abnormalities
ESTES Criteria for LVH ("diagnostic", >5 points; "probable", 4 points)
+ECG Criteria Points
a.Voltage Criteria (any of): R or S in limb leads >20 mm b.S in V1 or V2 > 30 mm c.R in V5 or V6 >30 mm
3 points
ST-T Abnormalities:Without digitalisWith digitalis
3 points1 point
Left Atrial Enlargement in V1 3 points
Left axis deviation 2 points
QRS duration 0.09 sec 1 point
Delayed intrinsicoid deflection in V5 or V6 (>0.05 sec) 1 point
c.ESTES Criteria for LVH ("diagnostic", >5 points; "probable", 4 points)
Analyse Stephen’s ECG
RV Hypertrophy
• Right axis deviation• Tall R-waves in RV leads (look at aVR)• Deep S-waves in LV leads • ST-T changes