Aortic stenosis electrocardiogram: Difference between revisions
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*Romhilt has reviewed ECG LVH criteria and gives an overview of the many LVH scoring systems <ref name="pmid4240354">{{cite journal| author=Romhilt DW, Bove KE, Norris RJ, Conyers E, Conradi S, Rowlands DT et al.| title=A critical appraisal of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy. | journal=Circulation | year= 1969 | volume= 40 | issue= 2 | pages= 185-95 | pmid=4240354 | doi= | pmc= | url= }} </ref>. In the '''Romhilt-Estes Score''' LVH is ''likely'' with 4 or more points. LVH is ''present'' with 5 or more points <ref name="pmid4231231">{{cite journal| author=Romhilt DW, Estes EH| title=A point-score system for the ECG diagnosis of left ventricular hypertrophy. | journal=Am Heart J | year= 1968 | volume= 75 | issue= 6 | pages= 752-8 | pmid=4231231 | doi= | pmc= | url= }} </ref>. | *Romhilt has reviewed ECG LVH criteria and gives an overview of the many LVH scoring systems <ref name="pmid4240354">{{cite journal| author=Romhilt DW, Bove KE, Norris RJ, Conyers E, Conradi S, Rowlands DT et al.| title=A critical appraisal of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy. | journal=Circulation | year= 1969 | volume= 40 | issue= 2 | pages= 185-95 | pmid=4240354 | doi= | pmc= | url= }} </ref>. In the '''Romhilt-Estes Score''' LVH is ''likely'' with 4 or more points. LVH is ''present'' with 5 or more points <ref name="pmid4231231">{{cite journal| author=Romhilt DW, Estes EH| title=A point-score system for the ECG diagnosis of left ventricular hypertrophy. | journal=Am Heart J | year= 1968 | volume= 75 | issue= 6 | pages= 752-8 | pmid=4231231 | doi= | pmc= | url= }} </ref>. | ||
Left ventricular hypertrophy has prognostic consequences as has been found in several studies <ref name="pmid11352882">{{cite journal| author=Sundström J, Lind L, Arnlöv J, Zethelius B, Andrén B, Lithell HO| title=Echocardiographic and electrocardiographic diagnoses of left ventricular hypertrophy predict mortality independently of each other in a population of elderly men. | journal=Circulation | year= 2001 | volume= 103 | issue= 19 | pages= 2346-51 | pmid=11352882 | doi= | pmc= | url= }} </ref><ref name="pmid7923663">{{cite journal| author=Levy D, Salomon M, D'Agostino RB, Belanger AJ, Kannel WB| title=Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy. | journal=Circulation | year= 1994 | volume= 90 | issue= 4 | pages= 1786-93 | pmid=7923663 | doi= | pmc= | url= }} </ref>. | |||
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Revision as of 18:54, 21 October 2011
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Aortic Stenosis Microchapters |
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Diagnosis |
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Treatment |
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Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty |
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Transcatheter Aortic Valve Replacement (TAVR) |
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Case Studies |
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Aortic stenosis electrocardiogram On the Web |
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American Roentgen Ray Society Images of Aortic stenosis electrocardiogram |
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Directions to Hospitals Treating Aortic stenosis electrocardiogram |
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Risk calculators and risk factors for Aortic stenosis electrocardiogram |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Mohammed A. Sbeih, M.D. [2], Claudia P. Hochberg, M.D. [3], Abdul-Rahman Arabi, M.D. [4], Keri Shafer, M.D. [5], Priyamvada Singh, MBBS [6]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [7]
Overview
Electrocardiogram may be used as a diagnostic tool in the evaluation of aortic stenosis. ECG findings associated with aortic stenosis include left ventricular hypertrophy and heart block.
Electrocardiogram
Although aortic stenosis does not lead to any specific findings on the ECG, it still often leads to a number of electrocardiographic abnormalities. ECG manifestations of left ventricular hypertrophy (LVH) are common in aortic stenosis and arise as a result of the stenosis having placed a chronically high pressure load on the left ventricle (with LVH being the expected response to chronic pressure loads on the left ventricle no matter how caused).
As noted below, the calcification process which occurs in aortic stenosis can progress to extend beyond the aortic valve and into the electrical conduction system of the heart. Evidence of this phenomenon may include heart block that is apparent on the ECG but otherwise undetectable.
As the left ventricular wall becomes thicker, the QRS complexes become larger. This is especially true for leads V1-V6. The S wave in V1 is deep, the R wave in V4 is high. Often some ST depression can be seen in leads V5-V6, which is in this setting is called a 'strain pattern'.
To diagnose left ventricular hypertrophy on the ECG one of the following criteria should be met:
- The Sokolow-Lyon criterium:
- R in V5 or V6 + S in V1 >35 mm.
- Other criteria:
- R >26 mm in V5 or V6.
- R >20 mm in I, II or III.
- R >12 mm in aVL (in the absence of left anterior fascicular block).
- The Cornell-criterium has different values in men and women:
- R in aVL and S in V3 >28 mm in men
- R in aVL and S in V3 >20 mm in women
- Romhilt has reviewed ECG LVH criteria and gives an overview of the many LVH scoring systems [1]. In the Romhilt-Estes Score LVH is likely with 4 or more points. LVH is present with 5 or more points [2].
Left ventricular hypertrophy has prognostic consequences as has been found in several studies [3][4].
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Another example of extreme left ventricular hypertrophy in a patient with severe aortic valve stenosis.
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ECG of a patient with LVH and subendocardial ischemia leading to positive cardiovascular markers in blood testing.
- Left ventricular hypertrophy; left ventricular strain due to aortic stenosis.
- Aortic Stenosis Hemodynamic Pressure Tracing.
References
- ↑ Romhilt DW, Bove KE, Norris RJ, Conyers E, Conradi S, Rowlands DT; et al. (1969). "A critical appraisal of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy". Circulation. 40 (2): 185–95. PMID 4240354.
- ↑ Romhilt DW, Estes EH (1968). "A point-score system for the ECG diagnosis of left ventricular hypertrophy". Am Heart J. 75 (6): 752–8. PMID 4231231.
- ↑ Sundström J, Lind L, Arnlöv J, Zethelius B, Andrén B, Lithell HO (2001). "Echocardiographic and electrocardiographic diagnoses of left ventricular hypertrophy predict mortality independently of each other in a population of elderly men". Circulation. 103 (19): 2346–51. PMID 11352882.
- ↑ Levy D, Salomon M, D'Agostino RB, Belanger AJ, Kannel WB (1994). "Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy". Circulation. 90 (4): 1786–93. PMID 7923663.