CMC ECG MASTERS
  • Home
    • About Us
    • EM GuideWire
    • CMC Ed Masters
    • Ped EM Morsels
  • Basics
  • P Waves
    • Sinus
    • Not sinus
    • Absent
  • PR interval
    • Short PR
    • Prolonged PR
    • Variable PR
  • QRS
    • Wide
    • Axis >
      • LAD
      • RAD
    • Amplitude >
      • High Voltage
      • Low Voltage
      • Alternans
    • R Wave Progression
    • Pathological Q waves
  • ST Segments
    • ST Elevation
    • ST Depression
  • T Waves
    • Flat, Bifid, or Notched
    • Inverted
  • QT intervals
    • Prolonged QT
    • Short QT
  • Patterns
    • STEMI
    • Pulmonary Embolism
    • Ventricular Hypertrophy
    • Pulmonary Disease
    • ST-T Patterns
    • Electrolyte Abnormalities
    • Cases >
      • Case 1
      • Case 2
      • Case 3
      • Case 4
      • Case 5
      • Case 6
      • Case 7
      • Case 8
      • Case 9
      • Case 10
      • Case 11
      • Case 12
      • Case 13
      • Case 14
      • Case 15
      • Case 16
      • Case 17
      • Case 18
      • Case 19
  • Interpreter

Ventricular Hypertrophy

LVH with strain
  • Voltage criteria for LVH
  • Left atrial enlargement
  • Left axis deviation
  • Subtle QRS widening (0.11 - 0.13 s)
  • Repolarization abnormality (strain pattern or any other ST-T abnormality)
  • Definition of strain pattern: “Upward convex ST depression followed by non-symmetrical T wave inversion (shallow downslope, rapid upslope) in leads with upright QRS complexes”
  • “Mirror image” strain pattern may cause ST elevation in V1-V2
  • ECG evaluation for “coronary ischemia” is limited in the presence of LVH with strain
Picture

RVH
  • Common but less specific findings: frequently reflects pulmonary hypertension
  • Right atrial enlargement
  • Right axis deviation
  • R/S ratio in V1 >1
  • R/S ratio in V6 <1
  • qR complex in V1
  • Inverted T waves in V1-V3
  • Inverted T waves in the inferior leads
  • Uncommon finding but highly specific for severe RVH
    • QRS narrow but upgoing in V1
    • QRS in V1 may start with a narrow Q wave (qR pattern)
    • ST segment depressed and T wave inverted in V1-V2 (strain pattern)
Picture
Pulmonary Embolism
Pulmonary Disease
  • Home
    • About Us
    • EM GuideWire
    • CMC Ed Masters
    • Ped EM Morsels
  • Basics
  • P Waves
    • Sinus
    • Not sinus
    • Absent
  • PR interval
    • Short PR
    • Prolonged PR
    • Variable PR
  • QRS
    • Wide
    • Axis >
      • LAD
      • RAD
    • Amplitude >
      • High Voltage
      • Low Voltage
      • Alternans
    • R Wave Progression
    • Pathological Q waves
  • ST Segments
    • ST Elevation
    • ST Depression
  • T Waves
    • Flat, Bifid, or Notched
    • Inverted
  • QT intervals
    • Prolonged QT
    • Short QT
  • Patterns
    • STEMI
    • Pulmonary Embolism
    • Ventricular Hypertrophy
    • Pulmonary Disease
    • ST-T Patterns
    • Electrolyte Abnormalities
    • Cases >
      • Case 1
      • Case 2
      • Case 3
      • Case 4
      • Case 5
      • Case 6
      • Case 7
      • Case 8
      • Case 9
      • Case 10
      • Case 11
      • Case 12
      • Case 13
      • Case 14
      • Case 15
      • Case 16
      • Case 17
      • Case 18
      • Case 19
  • Interpreter