Tricuspid regurgitation electrocardiogram
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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 consequence of TR itself. In case of TR secondary to left heart disease, the ECG might demonstrate changes related to the underlying condition.
Electrocardiogram
Right Atrial Enlargement
ECG findings of right atrial enlargement include:
Shown below is an ECG demonstrating large P waves in leads to 2,3, and aVF which have a P-wave height greater than 2.5 mm consistent with right each one enlargement:
Right Ventricular Hypertrophy
ECG findings of right ventricular hypertrophy include:
- Right axis deviation of +90 degrees or more
- The R wave in V1 is 7 mm or more in height
- 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 P congenitale
- S1 S2 S3 pattern in children
Shown below is an ECG demonstrating right ventricular hypertrophy. Note that R wave > the S wave in V1.
2008 and Incorporated 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT) [1]
Adolescents (DO NOT EDIT) [1]
| 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
- ↑ 1.0 1.1 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
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