ECG in atrio ventricular enlargement

1. ECG Changes in
atrioventricular
enlargement
Prepared by,
Jesna Krishnan
CON, ACME, Pariyaram

2. CHAMBER ENLARGEMENT
• Enlargement of atria or ventricle or
both.
• It implies dilation or hypertrophy.
• Dilation implies an increase in internal
diameter of cardiac chamber due to
volume overload.
• Hypertrophy occurs due to pressure
or systolic overload or both.

3. ATRIAL ENLARGEMENT
• Left atrial, right atrial, biatrial
enlargement
• In 12 lead ecg it is characterized by
changes in the P wave duration
and morphology.

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6. Atrial Enlargement/Hypertrophy
• Etiology:
– Valvular heart disease
– Congenital heart disease
– Atrial hypertrophy secondary to
ventricular hypertrophy
– Pulmonary hypertrophy and PAH

7. ECG Criteria in atrial hypertrophy
• Expressed in P wave abnormalities

8. ECG Criteria in atrial
hypertrophy
Normal P wave characteristics:
• Pyramidal in shape with rounded apex
• Always positive in lead II and negative in
aVR
• Duration:0.08 sec to 0.10sec
• Height and width: < 2.5 mm
• P wave axis is +45 to +65 clockwise.
• >65 indicates Rt. axis deviation
• <45 indicates Lt. Axis deviation

9. ATRIAL ENLARGEMENT
• P wave abnormalities:
Rt. atrial enlargement/ hypertrophy:
• Increases the height of the P
wave
Lt. atrial enlargement :
• Widens the P wave

10. RIGHT ATRIAL ENLARGEMENT
• Increase in muscle mass cause delay
in conduction.
• Reflected as increased voltage of P
wave
• It produces rotational effect which is
reflected in QRS abnormalities.

11. RIGHT ATRIAL ENLARGEMENT
• ECG changes of rt atrial hypertrophy is
divided in to 2:
1. Direct
Reflected by one or more of the
following manifestations.
• Tall P wave with rt axis deviation :- P
pulmonalae: Seen in leads II, III, aVF

12. • Abnormalities in P wave axis
– Directed towards rt axis +70 to +90
– Up right deflection of biphasic P
wave in lead II or V1.
– Early negative deflection of P
wave in lead V1

16. Normal QRS complex

17. 2. Indirect:
2 characteristic feature of QRS
Complex suggest rt. Atrial
enlargement.
– QR complex in lead V1
– Diminution in height of QRS
complex in lead V1 with marked
increase in its height in lead V2

18. • Twave inversion in lead v1-v2 and
sometimes v3 and v4
• Deep s waves in lead v6

26. Ventricular enlargement
• Left Ventricular, right ventricular,
biventricular enlargement
• In 12 lead ecg it is characterized by
changes in the QRS complex

28. Basic ECG presentation of RVH
• Right axis deviation is the commonest
and at times only presentation usually
directed from +90 to +180 degree.
• Such right axis deviation is usually an
expression of free Right wall
hypertrophy.

33. ST Segment and T Wave
• When RV under strain due to increased
right ventricular pressure the T wave vector
is directed away from the right resulting in T
wave inversion in right oriented leads.
• T wave inversion is most marked in V1 and
V2
• With severe compromised RV the inverted
T wave may be very deep, symmetrical,
pointed and tend to ischemic type.
• ST Segment is minimally depressed and
slightly convex upwards.

40. BIVENTRICULA
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HYPERTROPHY