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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 Sãng P réng (>0,12s) vµ cã khÝa ë DII, DIII; hai pha ë chuyÓn ®¹o V1 – TÊt c¶ c¸c tiªu chuÈn cho nhÜ tr¸i kh«ng b×nh th­êng hoÆc dÇy nhÜ (LAE). Kho¶ng PR > 0,2s: Block AV cÊp I.

Severe RVH - Trôc P râ (+150 degrees) - D¹ng qR ë V1, R/S ë V1 > 1; S/R ë V6 > 1 - ST chªnh dèc xuèng ë c¸c chuyÓn ®¹o tr­íc tim ph¶i

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 vµ cã khÝa ë DII; hai pha ë chuyÓn ®¹o V1 - Kho¶ng 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 - Sãng P réng (>0.12s) vµ cã khÝa ë DII, DIII; hai pha ë chuyÓn ®¹o 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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