ECG Criteria: Difference between revisions
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* Lead misplacement in a cranial direction | * Lead misplacement in a cranial direction | ||
* Normal variant | * Normal variant | ||
==ST Elevation== | |||
==ST Depression== | |||
==T Wave Inversion== | |||
==Low Voltage== | |||
==References== | ==References== | ||
Revision as of 23:41, 10 November 2016
| ECG Criteria |
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▸ Axis Deviation
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▸ Conduction Disturbance
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▸ Chamber Abnormality
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▸ Miscellaneous
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Left Axis Deviation
Criteria
- QRS axis between -30º and -90º
- Dominant S wave (S > R) in lead II and aVF
Causes
- Left bundle branch block
- Left anterior fascicular block
- Left ventricular hypertrophy
- Inferior myocardial infarction
- Ostium primum atrial septal defect
- Tricuspid atresia
- WPW syndrome with right-sided accessory pathway
- Ventricular pacing
- Ventricular ectopy
- Hyperkalemia
- Mechanical shifts, such as expiration, high diaphragm (pregnancy, ascites, abdominal tumor)
- Normal variation (physiologic, often with age)
Right Axis Deviation
Criteria
- QRS axis between +90º and +180º
- Dominant S wave (S > R) in lead I and aVL
Causes
- Right ventricular strain
- Lateral wall myocardial infarction
- Left posterior fascicular block
- Ventricular ectopy
- WPW syndrome with left-sided accessory pathway
- Mechanical shifts, such as inspiration and emphysema
- Normal variation in children or thin adults with a horizontally oriented heart
- Dextrocardia
- Pectus excavatum
- Reversed arm leads
Northwest Axis ('No Man's Land')
Criteria
- QRS axis between -90º and -180º
Causes
Left Anterior Fascicular Block
Criteria
- Frontal plane axis between 45° and 90°.
- qR pattern in lead aVL.
- R-peak time in lead aVL of 45 ms or more.
- QRS duration less than 120 ms.
Left Posterior Fascicular Block
Criteria
- Frontal plane axis between 90° and 180° in adults. Owing to the more rightward axis in children up to 16 years of age, this criterion should only be applied to them when a distinct rightward change in axis is documented.
- rS pattern in leads I and aVL.
- qR pattern in leads III and aVF.
- QRS duration less than 120 ms.
Left Bundle Branch Block
Criteria
- QRS duration ≥ 120 ms in adults, ≥ 100 ms in children 4 to 16 years of age, and ≥ 90 ms in children less than 4 years of age.
- Broad notched or slurred R wave in leads I, aVL, V5, and V6 and an occasional RS pattern in V5 and V6 attributed to displaced transition of QRS complex.
- Absent q waves in leads I, V5, and V6 (or a narrow q wave in aVL in the absence of myocardial pathology).
- R peak time greater than 60 ms in leads V5 and V6 but normal in leads V1, V2, and V3, when small initial r waves can be discerned in the above leads.
- ST and T waves opposite in direction of QRS deflections.
Right Bundle Branch Block
Criteria
- QRS duration greater than or equal to 120 ms in adults, greater than 100 ms in children ages 4 to 16 years, and greater than 90 ms in children less than 4 years of age.
- rsr , rsR , or rSR in leads V1 or V2. The R or r deflection is usually wider than the initial R wave. In a minority of patients, a wide and often notched R wave pattern may be seen in lead V1 and/or V2.
- S wave of greater duration than R wave or greater than 40 ms in leads I and V6 in adults.
- Normal R peak time in leads V5 and V6 but greater than 50 ms in lead V1.
Left Atrial Enlargement
Criteria
- P wave duration ≥ 110 ms (sensitivity 62%; specificity 86%)[1]
- Negative phase of P wave in V1 ≥ 40 ms (sensitivity 20%; specificity 98%)
- P terminal force in V1 ≥ 40 msec-mm (sensitivity 56%; specificity 95%)
- Negative phase of P wave in V1 > 1 mm
- Notched P wave with interpeak interval > 40 ms
- P wave/PR duration > 1.6
Right Atrial Enlargement
Criteria
- A tall upright P wave in lead II (> 2.5 mm), often with a peaked or pointed appearance.
- Prominent initial positivity of the P wave in V1 or V2 (≥ 1.5 mm).
Left Ventricular Hypertrophy
Criteria
- Romhilt-Estes criteria (4 points = probable, 5 points = definite):
- Largest R or S in limb leads ≥ 20 mm or S in V1 or V2 ≥ 30 mm or R in V5 or V6 ≥30 mm (3 points)
- ST displacement opposite to QRS deflection: without digoxin (3 points); with digoxin (1 point)
- LAA (3 points)
- LAD (2 points)
- QRS duration ≥ 90 ms (1 point)
- Intrinsicoid deflection (QRS onset to peak of R) in V5 or V6 ≥ 50 ms (1 point)
- Sokolow-Lyon criteria:
- S in V1 + R in V5 or V6 ≥35 mm
- R in aVL ≥11 mm
- Cornell criteria:
- R in aVL + S in V3 >28 mm in men or >20 mm in women
- If LAD or LAFB, S in lead III + max (R+S) in precordial leads ≥ 30 mm
Right Ventricular Hypertrophy
Criteria
- Increased R/S ratio in V1 (> 1)
- Tall R wave in V1 (> 6 mm)
- Deep S wave in V5 (> 10 mm) or V6 (> 3 mm)
- Drop in R/S ratio across precordium (R/S ratio in V1 > R/S ratio in V3 or V4)
Biventricular Hypertrophy
Criteria
- ECG criteria for LVH plus the presence of:
- Prominent S waves in V5 or V6
- Right axis deviation
- Tall biphasic R/S complexes
- Right atrial enlargement
Pathologic Q Wave
QT Prolongation
Criteria
Causes
- Congenital
- Medications
- Antiarrhythmics (amiodarone, disopyramide, dronedarone, flecainide, sotalol)
- Antibiotics such as macrolides (erythromycin, clarithromycin, azithromycin) and quinolones (levofloxacin, moxifloxacin)
- Antifungals (fluconazole, ketoconazole)
- Antimotility and antiemetic agents (domperidone, granisetron, ondansetron)
- Antimalarials (quinine, chloroquine)
- Antihistamines (hydroxyzine)
- Antipsychotics (chlorpromazine, clozapine, droperidol, fluphenazine, haloperidol, olanzapine, pimozide, paliperidone, quetiapine, risperidone)
- Antidepressants (amitriptyline, citalopram, escitalopram, dosulepin, doxepin, fluoxetine, imipramine, lofepramine)
- Miscellaneous (methadone, foscarnet, sorafenib, sunitinib)
- Autonomic dysfunction
- Electrolyte imbalances
- Miscellaneous
Poor R Wave Progression
Criteria
- Loss of anterior forces without frank Q waves in precordial leads (decrease in R wave amplitude from V1 to V2, or V2 to V3, or V3 to V4)
- R wave in V3 ≤ 3 mm
Causes
- Prior anterior myocardial infarction
- Ventricular hypertrophy
- Left bundle branch block
- WPW syndrome
- Cardiomyopathy
- Emphysema
- Pneumothorax
- Clockwise rotation of the heart
- Lead misplacement in a cranial direction
- Normal variant
ST Elevation
ST Depression
T Wave Inversion
Low Voltage
References
- ↑ Hazen MS, Marwick TH, Underwood DA (1991). "Diagnostic accuracy of the resting electrocardiogram in detection and estimation of left atrial enlargement: an echocardiographic correlation in 551 patients". Am Heart J. 122 (3 Pt 1): 823–8. PMID 1831587.
- ↑ Rautaharju PM, Surawicz B, Gettes LS, Bailey JJ, Childers R, Deal BJ; et al. (2009). "AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology". J Am Coll Cardiol. 53 (11): 982–91. doi:10.1016/j.jacc.2008.12.014. PMID 19281931.
- ↑ Drug and Therapeutics Bulletin (2016). "QT interval and drug therapy". BMJ. 353: i2732. doi:10.1136/bmj.i2732. PMID 27334640.