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==Overview==
==Overview==
The [[electrocardiogram]] ([[The electrocardiogram|ECG]]) in [[tricuspid regurgitation]] (TR) might have no significant abnormalities. Findings suggestive of [[right atrial enlargement]] and [[right atrial hypertrophy|hypertrophy]] might be present secondary to either [[pulmonary hypertension]] or to the [[hemodynamic]] consequences of TR itself. In the case of TR secondary to [[left heart]] disease, the [[ECG]] might demonstrate changes related to the underlying condition.
==Electrocardiogram==
An [[The electrocardiogram|ECG]] may be helpful in the diagnosis of [[tricuspid regurgitation]] (TR). Findings on an ECG suggestive of [[tricuspid regurgitation]] (TR) include:<ref name="pmid30252377">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=30252377 | doi= | pmc= | url= }}</ref><ref name="pmid18222317">{{cite journal| author=Shah PM, Raney AA| title=Tricuspid valve disease. | journal=Curr Probl Cardiol | year= 2008 | volume= 33 | issue= 2 | pages= 47-84 | pmid=18222317 | doi=10.1016/j.cpcardiol.2007.10.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18222317  }}</ref>
=== Right Atrial Enlargement ===
[[ECG]] findings of [[Right atrium|right atrial]] enlargement include:
* A [[P wave]] >2.5 mm in leads II, III and aVF
* A [[P wave]] >1.5 mm in lead V1
Shown below is an [[The electrocardiogram|ECG]] demonstrating large [[P wave|P waves]] in leads to II, III, and aVF, which have a [[P-wave]] height greater than 2.5 mm consistent with [[Right atrium|right atrial]] enlargement:
===Right Ventricular Hypertrophy===
[[ECG]] findings of [[right ventricular hypertrophy]] include:
* [[Right axis deviation]] of +90 degrees or more
* RV1 = 7 mm or more
* RV1 + SV5 or SV6 = 10 mm or more
* R/S ratio in V1 = 1.0 or more
* S/R ratio in V6 = 1.0 or more
* Late intrinsicoid deflection in V1 (0.035+)
* Incomplete [[RBBB]] pattern
* ST T strain pattern in 2,3,aVF
* [[P pulmonale]] or [[Right atrial enlargement]] or P congenitale
* S1 S2 S3 pattern in children
* Tall [[R wave]] in V1 or qR in V1
* R wave greater than [[S wave]] in V1
* R wave progression reversal
* Inverted [[T wave]] in the anterior precordial leads
Shown below is an [[The electrocardiogram|ECG]] tracing from lead V1 demonstrating [[right ventricular hypertrophy]].


==2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) <ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>==
==2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) <ref name="pmid18820172">{{cite journal |author=Bonow RO, Carabello BA, Chatterjee K, ''et al.'' |title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons |journal=Circulation |volume=118 |issue=15 |pages=e523–661 |year=2008 |month=October |pmid=18820172 |doi=10.1161/CIRCULATIONAHA.108.190748 |url=}}</ref>==
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' An [[ECG]] is indicated for the initial evaluation of adolescent and young adult patients with [[TR]], and serially every 1 to 3 years,                                          depending on severity. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
| bgcolor="lightgreen" |<nowiki>"</nowiki>'''1.''' An [[ECG]] is indicated for the initial evaluation of adolescent and young adult patients with [[TR]], and serially every 1 to 3 years,                                          depending on severity. ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|}
|}


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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' [[Holter monitoring]] may be considered for the initial evaluation of asymptomatic adolescent and young adult patients with [[TR]], and serially every 1 to 3 years.  ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
| bgcolor="lemonchiffon" |<nowiki>"</nowiki>'''1.''' [[Holter monitoring]] may be considered for the initial evaluation of asymptomatic adolescent and young adult patients with [[TR]], and serially every 1 to 3 years.  ([[ACC AHA guidelines classification scheme#Level of Evidence|''Level of Evidence: C'']])<nowiki>"</nowiki>
|}
|}


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{{reflist|2}}
{{reflist|2}}


[[Category:Valvular heart disease]]
[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Cardiology]]


{{WH}}
{{WH}}
{{WS}}
{{WS}}

Latest revision as of 04:21, 28 April 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Overview

The electrocardiogram (ECG) in tricuspid regurgitation (TR) might have no significant abnormalities. Findings suggestive of right atrial enlargement and hypertrophy might be present secondary to either pulmonary hypertension or to the hemodynamic consequences of TR itself. In the case of TR secondary to left heart disease, the ECG might demonstrate changes related to the underlying condition.

Electrocardiogram

An ECG may be helpful in the diagnosis of tricuspid regurgitation (TR). Findings on an ECG suggestive of tricuspid regurgitation (TR) include:[1][2]

Right Atrial Enlargement

ECG findings of right atrial enlargement include:

  • A P wave >2.5 mm in leads II, III and aVF
  • A P wave >1.5 mm in lead V1

Shown below is an ECG demonstrating large P waves in leads to II, III, and aVF, which have a P-wave height greater than 2.5 mm consistent with right atrial enlargement:

Right Ventricular Hypertrophy

ECG findings of right ventricular hypertrophy include:

  • RV1 = 7 mm or more
  • RV1 + SV5 or SV6 = 10 mm or more
  • R/S ratio in V1 = 1.0 or more
  • S/R ratio in V6 = 1.0 or more
  • Late intrinsicoid deflection in V1 (0.035+)
  • Incomplete RBBB pattern
  • ST T strain pattern in 2,3,aVF
  • P pulmonale or Right atrial enlargement or P congenitale
  • S1 S2 S3 pattern in children
  • Tall R wave in V1 or qR in V1
  • R wave greater than S wave in V1
  • R wave progression reversal
  • Inverted T wave in the anterior precordial leads

Shown below is an ECG tracing from lead V1 demonstrating right ventricular hypertrophy.

2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) [3]

Adolescents (DO NOT EDIT) [3]

Class I
"1. An ECG is indicated for the initial evaluation of adolescent and young adult patients with TR, and serially every 1 to 3 years, depending on severity. (Level of Evidence: C)"
Class IIb
"1. Holter monitoring may be considered for the initial evaluation of asymptomatic adolescent and young adult patients with TR, and serially every 1 to 3 years. (Level of Evidence: C)"

References

  1. ↑ "StatPearls". 2020. PMID 30252377.
  2. ↑ Shah PM, Raney AA (2008). "Tricuspid valve disease". Curr Probl Cardiol. 33 (2): 47–84. doi:10.1016/j.cpcardiol.2007.10.004. PMID 18222317.
  3. ↑ 3.0 3.1 Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter |month= ignored (help)

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