Atrial and Ventricular

Enlargement
Chapter 6
Cardiac Enlargement
dilation

stretched

congestive heart failure

hypertrophy

increase size of heart muscle fibers

aortic stenosis
Cardiac Enlargement

Increase amount of cardiac tissue

How would this affect amount of depolarization?

How could that affect an ECG?

Right Atrial Abnormality

Overload of the right atria

dilation

hypertrophy

Increase voltage of the P wave

Right Atrial Abnormality

Normal P wave amplitude is less than 2.5 mm and

0.12 seconds in width.

Abnormal P waves are typically taller than 2.5 mm

but not longer the 0.12 sec.
Right Atrial Abnormality

Causes:

Pulmonary disease

Congenital heart disease

 Right Atrial
Abnormality
• Tall P waves in any of the following leads:
• II, III, aVF or sometimes V1.
Right Atrial Abnormality

P pulmonale

artial enlargement due to severe pulmonary disease

Atrial enlargement can occur in the absence of tall P

waves.
Left Atrial Abnormality
Left atria normally depolarizes after the right atria.

Left atrial enlargement should prolong the P wave

greater than 0.12 sec.

P wave height may be normal or increased

Left Atrial Abnormality

CAD may produce wide P waves without left atrial

enlargement.
 Left Atrial Abnormality
• Leads I and/or II may
show notched P waves
• (second hump due to
delayed depolarization of
the left atrium)
• (P mitrale: mitral valve
disease)
• V1 may show a bi-phasic
P wave
• negative part is > 0.4 sec.
or 1 mm in depth
• (right atria is anterior to the
left atria)
Left Atrial Abnormality

Causes:

Valvular heart disease

Hypertensive heart disease

Cardiomyopathies

CAD
Right Ventricular
Hypertrophy

What do you think will happen to the ECG with

ventricular hypertrophy?
 Normal QRS

V6?
V6?

V1? V1?

FIG. 4-6
Normal QRS

V1
V6
Right Ventricular
Hypertrophy

Consider right ventricular hypertrophy and V1

NORMAL HYPERTROPHY
 Right Ventricular
Hypertrophy

1. In V1, R wave is greater than the S wave

2. In V1, T wave inversion (reason unknown)
3. Right axis deviation
Right Ventricular
Hypertrophy
Causes of RVH

congenital heart disease

atrial septal defects

others

Emphysema may mask signs of RVH

Left Ventricular
Hypertrophy
With LVH, the electrical balance is tipped even
further to the left.

Predominate S waves in the right chest leads

Tall R waves in the left chest leads

 Left Ventricular
Hypertrophy
• If S wave in V
1+ R wave in either V5 or V6
> 35 mm (not specific indicator).
• R wave > 11-13 mm in aV L

• ST segment changes
• Left axis deviation
• Left atrial abnormality
ST strain patterns
Left Ventricular
Hypertrophy
Causes:

Hypertension

Aortic stenosis

Risks of LVH

congestive heart failure

arrhythmias
Left Ventricular
Hypertrophy

High voltage can be seen in normal people,

especially athletes

Hypertrophy in both ventricles the ECG will show

more evidence of LVH