Atrial and Ventricular
Hypertrophy.
ECG Features and Common
Causes.
Aims and Objectives.
 Understand pathophysiology of types of
hypertrophy.
 Common patient presentation and
symptoms.
 ECG appearances associated with different
types of hypertrophy.
 Pitfalls in diagnosis from ECG.
Left Atrial Hypertrophy /
Enlargement.
 Thickening of wall.
 Dilatation of chamber
(enlargement).
 Increased volume.
 Increased muscle
mass.
Some causes.
 Mitral and / or aortic valve disease.
 Left ventricular systolic and diastolic
dysfunction.
 Cardiomyopathy - hypertrophic / dilated.
 Atrial fibrillation.
 Left atrial mass.
 Hypertension.
ECG appearances.
Appearances cont..
Common ECG Features of LAH.
 Usually seen in late portion of P wave.
 Often biphasic in V1 - larger negative
deflection.
– RA conducts anteriorly (+ initially)
– Large LA mass conducts posteriorly (-ive
component).
• Prolonged P wave duration (>0.12 secs).
• Pronounced notch with peak to peak
>0.04secs.
Right Atrial Hypertrophy /
Enlargement.
Some causes.





Tricuspid and / or pulmonary valve disease.
Lung disease.
Congenital heart disease (ASD, PFO, VSD).
RV systolic and diastolic dysfunction.
Mitral stenosis (pressure back-up).
RAH Appearance.
Common ECG Appearance.
 Tall, peaked P wave (>2.5mm).
 Best seen lead II - often throughout ECG.
 Known as P pulmonale.
Left Ventricular Hypertrophy.
 Thickened walls.
 Dilated chamber.
 Increased muscle mass or
increased volume.
Some causes of LVH.





Aortic valve disease.
Coarctation of the aorta.
Cardiomyopathy - dilated, hypertrophic.
Hypertension.
Heart Failure - systolic.
Left Ventricular Hypertrophy
Appearance.
LVH Appearance.
Commonly Used Criteria for LVH.
 Scoring System.
 Suggested if >5 points.
 Chou, T. and Knilans,
T.K. (1996).
Electrocardiography in
Clinical Practise. 4th
Ed. Philadelphia:
Saunders.
 ECG Feature:

Amplitude:
– Largest R or S wave in limb leads
>20mm.
– S wave leads V1 and V2 >30mm.
– R waves in leads V5 or V6 >30mm.
3 POINTS.
ST-T wave changes typical for LVH. 3
POINTS.
Left atrial involvement. 3 POINTS.
Left axis deviation. 2 POINTS.
QRS Duration of >0.09s. 1 POINT.
Right Ventricular Hypertrophy.
Some causes of RVH.
 Pulmonary hypertension (numerous causes
- primary and secondary - also cor
pulmonale).
 Mitral stenosis.
 Pulmonary valve disease.
 Congenital heart disease (VSD, Ebsteins
Anomaly).
 RV systolic dysfunction (e.g. post inferior
MI).
ECG Appearance Right Ventricular
Hypertrophy.
ECG Criteria for RVH.
 Right axis deviation of +110 degrees or
more.
 Dominant R wave in lead V1.
 R wave in lead V1 >7mm.
 Other supporting criteria:
– ST segment depression and T inversion V1 V4.
– Deep S waves V5, V6, I and aVL.
Conclusion.
 LAH – ECG appearance and common
causes.
 RAH – appearance and causes.
 LVH – appearance, certainty of diagnosis,
causes and pitfalls.
 RVH – appearance, causes and pitfalls.