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ECG of the Enlarged Heart
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The Cardiac Cycle
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Know this
During examinationV follows S2 and should beVisible with elevated JVP
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Mitral Regurg
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Aortic Regurg
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Mitral Stenosis
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Aortic Stenosis
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What are the features of this ECG
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Relations of ECG leads
aVRRV
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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
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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
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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)
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Analyse Stephen’s ECG
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RV Hypertrophy
• Right axis deviation• Tall R-waves in RV leads (look at aVR)• Deep S-waves in LV leads • ST-T changes