Pulmonary hypertension electrocardiogram: Difference between revisions
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Lisa Prior (talk | contribs) New page: {{Pulmonary hypertension}} '''Editor(s)-in-Chief:''' C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; '''Assistant Editor(s)-in-Ch... |
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'''Editor(s)-in-Chief:''' [[User:C Michael Gibson |C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; '''Assistant Editor(s)-in-Chief:''' [[User:Lisa Prior|Lisa Prior]] | '''Editor(s)-in-Chief:''' [[User:C Michael Gibson |C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; '''Assistant Editor(s)-in-Chief:''' [[User:Lisa Prior|Lisa Prior]] | ||
==Background== | |||
Elevated pulmonary pressures can lead to '''right ventricular hypertrophy''' (RVH) and '''right atrial enlargement'''. | Elevated pulmonary pressures can lead to '''right ventricular hypertrophy''' (RVH) and '''right atrial enlargement'''. | ||
These pathological changes may sometimes manifest on electrocardiogram. | These pathological changes may sometimes manifest on electrocardiogram. | ||
==ECG findings suggestive of RVH in pulmonary hypertension== | |||
*Right axis deviation | *Right axis deviation | ||
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*Right Bundle Branch block: QRS duration> 0.12 seconds, rSR' in leads V1 & V2, wide slurred S waves in lateral leads (V5, V6, I) <ref name="isbn0-7637-6405-1">{{cite book |author=O'Keefe, James |title=The Complete Guide to ECGS |publisher=Jones & Bartlett Pub |location= |year=2008 |pages= |isbn=0-7637-6405-1 |oclc= |doi= |accessdate=}}</ref> | *Right Bundle Branch block: QRS duration> 0.12 seconds, rSR' in leads V1 & V2, wide slurred S waves in lateral leads (V5, V6, I) <ref name="isbn0-7637-6405-1">{{cite book |author=O'Keefe, James |title=The Complete Guide to ECGS |publisher=Jones & Bartlett Pub |location= |year=2008 |pages= |isbn=0-7637-6405-1 |oclc= |doi= |accessdate=}}</ref> | ||
==ECG findings suggestive of right atrial enlargment== | |||
*P 'pulomale': P wave amplitude >2.5mm in inferior leads (II, III, AVF) or >1.5mm in V1/V2 | *P 'pulomale': P wave amplitude >2.5mm in inferior leads (II, III, AVF) or >1.5mm in V1/V2 | ||
*P wave axis shifted rightward >70° <ref name="isbn0-7637-6405-1">{{cite book |author=O'Keefe, James |title=The Complete Guide to ECGS |publisher=Jones & Bartlett Pub |location= |year=2008 |pages= |isbn=0-7637-6405-1 |oclc= |doi= |accessdate=}}</ref> | *P wave axis shifted rightward >70° <ref name="isbn0-7637-6405-1">{{cite book |author=O'Keefe, James |title=The Complete Guide to ECGS |publisher=Jones & Bartlett Pub |location= |year=2008 |pages= |isbn=0-7637-6405-1 |oclc= |doi= |accessdate=}}</ref> | ||
==Use as a prognostic tool== | |||
A number of studies have indicated that a qR pattern in V1 and a tall P wave in lead I point towards a worse outcome in patients with pulmonary hypertension <ref name="pmid11834666">{{cite journal |author=Bossone E, Paciocco G, Iarussi D, ''et al.'' |title=The prognostic role of the ECG in primary pulmonary hypertension |journal=Chest |volume=121 |issue=2 |pages=513–8 |year=2002 |month=February |pmid=11834666 |doi= |url=}}</ref> | A number of studies have indicated that a qR pattern in V1 and a tall P wave in lead I point towards a worse outcome in patients with pulmonary hypertension <ref name="pmid11834666">{{cite journal |author=Bossone E, Paciocco G, Iarussi D, ''et al.'' |title=The prognostic role of the ECG in primary pulmonary hypertension |journal=Chest |volume=121 |issue=2 |pages=513–8 |year=2002 |month=February |pmid=11834666 |doi= |url=}}</ref> | ||
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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Assistant Editor(s)-in-Chief: Lisa Prior
Background
Elevated pulmonary pressures can lead to right ventricular hypertrophy (RVH) and right atrial enlargement. These pathological changes may sometimes manifest on electrocardiogram.
ECG findings suggestive of RVH in pulmonary hypertension
- Right axis deviation
- R/S ratio > 1 in V1
- R wave > 7mm in V1
- rSR' complex in V1 with R' > 10mm
- qR complex in V1
- Right ventricular strain pattern: ST and T wave inversion in V1-V3 and occasionally in inferior leads (II, III, AVF)
- Right Bundle Branch block: QRS duration> 0.12 seconds, rSR' in leads V1 & V2, wide slurred S waves in lateral leads (V5, V6, I) [1]
ECG findings suggestive of right atrial enlargment
- P 'pulomale': P wave amplitude >2.5mm in inferior leads (II, III, AVF) or >1.5mm in V1/V2
- P wave axis shifted rightward >70° [1]
Use as a prognostic tool
A number of studies have indicated that a qR pattern in V1 and a tall P wave in lead I point towards a worse outcome in patients with pulmonary hypertension [2] However up to 13% of patients with significant pulmonary hypertension were shown to have normal ECG findings indicating lack of senstivity and casting doubt on it's use a prognostic indicator.[3]
References
- ↑ 1.0 1.1 O'Keefe, James (2008). The Complete Guide to ECGS. Jones & Bartlett Pub. ISBN 0-7637-6405-1.
- ↑ Bossone E, Paciocco G, Iarussi D; et al. (2002). "The prognostic role of the ECG in primary pulmonary hypertension". Chest. 121 (2): 513–8. PMID 11834666. Unknown parameter
|month=ignored (help) - ↑ Ahearn GS, Tapson VF, Rebeiz A, Greenfield JC (2002). "Electrocardiography to define clinical status in primary pulmonary hypertension and pulmonary arterial hypertension secondary to collagen vascular disease". Chest. 122 (2): 524–7. PMID 12171826. Unknown parameter
|month=ignored (help)
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