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®äc ®iÖn tim Khoa HSCC BÖnhviÖn E • Left Atrial Abnormality & 1st degree AV Block-KH • Sãng P réng (>0,12s) vµ cã khÝa ë DII, DIII; hai pha ë chuyÓn ®¹o V1 • Left Atrial Abnormality & 1st Degree AV Block: Leads II and V1-KH - P > 0,12s vµ cã khÝa ë DII; hai pha ë chuyÓn ®¹o • Left Atrial Enlargement: Leads II and V1-KH II V1 • Left Atrial Enlargement-KH • Left atrial enlargement is illustrated by increased P wave duration in lead II, top ECG, and by the prominent negative P terminal force in lead V1, bottom tracing • Left Atrial Enlargement & Nonspecific ST-T Wave Abnormalities-KH • LAE is best seen in V1 with a prominent negative (posterior) component measuring 1mm wide and 1mm deep. There are also diffuse nonspecific ST-T wave abnormalities which must be correlated with the patient's clinical • LVH - Best seen in the frontal plane leads!-KH Lewis Index: 1) R in aVL >11 mm 2) R in I + S in III >25mm 3) (RI+SIII) - • LVH & PVCs: Precordial Leads-KH • LVH and Many PVCs-KH • The combination of voltage criteria (SV2 + RV6 >35mm) and ST-T abnormalities in V5-6 are definitive for LVH. There may also be LAE as evidenced by the prominent negative P terminal force in lead V1. Isolated PVCs and a PVC couplet are also present. • LVH: Limb Lead Criteria-KH Lewis Index: III >25mm 1) R in aVL >11 mm 2) R in I + S in • LVH: Limb Lead Criteria-KH • In this example of LVH, the precordial leads don't meet the usual voltage criteria or exhibit significant ST segment abnormalities. The frontal plane leads, however, show voltage criteria for LVH and significant ST segment depression in leads with tall R waves. The voltage criteria include 1) R in aVL >11 mm; 2) R in I + S in III >25mm; • LVH: Strain pattern + Left Atrial Enlargement-KH - SV2 + RV5 >35mm - Sãng P réng (>0.12s) vµ cã khÝa ë DII, • LVH with "Strain"-KH - SV2 + RV5 >35mm - Lewis Index: >25mm 1) R in aVL >11 mm 2) R in I + S in III • RAE & RVH-KH • Tiªu chuÈn ? • Right Atrial Enlargement (RAE) & Right Ventricular Hypertrophy (RVH)-KH • RAE is recognized by the tall (>2.5mm) P waves in leads II, III, aVF. RVH is likely because of right axis deviation (+100 degrees) • Right Axis Deviation & RAE (P Pulmonale): Leads I, II, III-KH • RVH with Right Axis Deviation • Note the qR pattern in right precordial leads. This suggests right ventricular pressures greater than left ventricular pressures. The persistent S waves in lateral precordial leads and the RAD are other finding in RVH. • Severe RVH ë V6 > 1 - Trôc P râ (+150 degrees) - D¹ng qR ë V1, R/S ë V1 > 1; S/R • Right Ventricular Hypertrophy (RVH) & Right Atrial Enlargement (RAE)-KH • In this case of severe pulmonary hypertension, RVH is recognized by the prominent anterior forces (tall R waves in V1-2), right axis deviation (+110 degrees), and "P pulmonale" (i.e., right atrial enlargement). RAE is best seen in the frontal plane leads; the P waves in lead II are >2.5mm in amplitude Xin tr©n träng c¸m ¬n !