Aortic regurgitation electrocardiogram

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview

Electrocardiographic abnormalities in the patient with aortic insufficiency include left ventricular hypertrophy and left axis deviation.

In aortic regurgitation, the electrocardiographic findings are nonspecific. However, the following may be noted:

Nonspecific changes of ST and T wave (due to left ventricular enlargement)
Right coronary artery ischemic changes (suggestive of aortic dissection)
- ST elevation in II, III, aVF (inferior MI)
- ST elevation in V3R and V4R (right ventricle MI)
- ST depression in V1-V3 (posterior MI)
Left ventricular hypertrophy
Left axis deviation
Left atrial enlargement
Left ventricular volume overload pattern (prominent Q waves in leads I, aVL, and V3 to V6 and relatively small R waves in V1)
Left ventricular conduction defects (typically late in the disease process)
Re-polarization abnormalities
ST-segment depression in precordial leads

Shown below is an ECG depicting left ventricular hypertrophy. Copyleft image obtained courtesy of ECGpedia [3]

Shown below is an ECG depicting left axis deviation. Copyleft image obtained courtesy of ECGpedia [4]