Pulmonary hypertension electrocardiogram: Difference between revisions
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==Overview== | ==Overview== | ||
Elevated pulmonary pressures can lead to [[right ventricular hypertrophy]] ([[RVH]]) and [[right atrial enlargement]] which can sometimes be observed on the electrocardiogram. | |||
Elevated pulmonary pressures can lead to | |||
==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 | ||
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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> | ||
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.<ref name="pmid12171826">{{cite journal |author=Ahearn GS, Tapson VF, Rebeiz A, Greenfield JC |title=Electrocardiography to define clinical status in primary pulmonary hypertension and pulmonary arterial hypertension secondary to collagen vascular disease |journal=Chest |volume=122 |issue=2 |pages=524–7 |year=2002 |month=August |pmid=12171826 |doi= |url=}}</ref> | 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.<ref name="pmid12171826">{{cite journal |author=Ahearn GS, Tapson VF, Rebeiz A, Greenfield JC |title=Electrocardiography to define clinical status in primary pulmonary hypertension and pulmonary arterial hypertension secondary to collagen vascular disease |journal=Chest |volume=122 |issue=2 |pages=524–7 |year=2002 |month=August |pmid=12171826 |doi= |url=}}</ref> | ||
==EKG Examples== | |||
Shown below is an example of right ventricular hypertrophy and right atrial enlargement in a patient with chronic pulmonary hypertension due to chronic embolization. | |||
[[Image:Pulhtn1.jpg|thumb|center|500px]] | |||
==References== | ==References== | ||
Revision as of 00:03, 24 September 2012
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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
Overview
Elevated pulmonary pressures can lead to right ventricular hypertrophy (RVH) and right atrial enlargement which can sometimes be observed on the 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]
EKG Examples
Shown below is an example of right ventricular hypertrophy and right atrial enlargement in a patient with chronic pulmonary hypertension due to chronic embolization.
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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