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• 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 t

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• LVH & PVCs: Precordial Leads-KH

• 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

II

V1

• 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) - (RIII+SI) >17mm

• 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)

• Left Atrial Abnormality & 1st degree AV

Block-KH

• Sóng P rộng (>0,12s) và có khía ở DII, DIII; hai pha ở chuyển đạo V1 – Tất cả các tiêu

chuẩn cho nhĩ trái không bình th ờng hoặc dầy nhĩ (LAE) Khoảng PR > 0,2s: Block AV cấp I.

• Severe RVH

- Trục P rõ (+150 degrees)

- Dạng qR ở V1, R/S ở V1 > 1; S/R ở V6 > 1

- ST chênh dốc xuống ở các chuyển đạo tr ớc tim phải

• 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; and 3) (RI+SIII) - (RIII+SI) >17mm (Lewis Index)

• Left Atrial Enlargement: Leads II and V1-KH

• RAE & RVH-KH

• Left Atrial Abnormality & 1st Degree AV Block: Leads

II and V1-KH

- P > 0,12s và có khía ở DII; hai pha ở chuyển đạo V1

- Khoảng PR > 0,2s

• 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 status Poor R wave progression in leads V1-V3, another nonspecific finding, is also present

• 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.

• Right Axis Deviation & RAE (P Pulmonale): Leads I, II, III-KH

• LVH: Limb Lead Criteria-KH

Lewis Index: 1) R in aVL >11 mm

2) R in I + S in III >25mm

3) (RI+SIII) - (RIII+SI) >17mm

• LVH: Strain pattern + Left Atrial Enlargement-KH

- SV2 + RV5 >35mm

- Sóng P rộng (>0.12s) và có khía ở DII, DIII; hai pha

ở chuyển đạo V1

• 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

• LVH with "Strain"-KH

- SV2 + RV5 >35mm

- Lewis Index: 1) R in aVL >11 mm

2) R in I + S in III >25mm

3) (RI+SIII) - (RIII+SI) >17mm

• 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

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