03 - Hypertrophy and Enlargement

Question 0

What is enlargement caused by?

Answer 0

Volume overload from aortic insufficiency or mitral regurgitation

Question 1

Enlargement vs hypertrophy

Answer 1

Enlargement happens when the chamber dilates to accommodate an increased amount of blood
Hypertrophy refers to an increased muscle mass

Question 2

What causes hypertrophy?

Answer 2

Pressure overload from systemic hypertension or aortic stenosis

Question 3

Enlargement and hypertrophy cause ______ in wave duration, ______ in wave amplitude, and _____ of electrical axis

Answer 3

Increase - chamber takes longer to depol
Increase - chamber can generate more current
Shift - larger percentage of total current can move through expanded chamber

Question 4

The ECG records the _________ of electrical forces at a given moment. The average vector of all of these is the _______. Its direction is called the

Answer 4

Instantaneous vector
Mean vector
Mean electrical axis

Question 5

Complete depol can be represented by

Answer 5

Sequential vectors

Question 6

The first vector represents ______ depol and each successive vector represents depol of the

Answer 6

Ventricles

Question 7

The mean electrical axis points

Answer 7

Leftward and inferiorly

Represents the average during ventricular depol

Question 8

Any mean QRS vector between -90 and +90 will produce positive QRS in

Answer 8

Lead I

Question 9

Any mean QRS vector between 0 and 180 produces a positive QRS in

Answer 9

Lead aVF

Question 10

If the QRS is positive in both lead I and aVF, the QRS axis lies between

Answer 10

0 and +90

Question 11

With right axis deviation, the deflections will be positive in ______ and negative in ______ with the electrical axis between

Answer 11

aVF, lead I

+90 and 180

Question 12

If the axis is between -90 and 180, this is called

The QRS complex will be

Answer 12

Extreme right axis deviation

Negative in both lead I and aVF

Question 13

The electrical axis lies between 0 and 90 for

Answer 13

Left axis deviation

Question 14

Left axis deviation has ______ aVF and ______ lead I

Answer 14

Negative

Positive

Question 15

All of the information needed to assess atrial enlargement is on leads

Answer 15

II and V1

Question 16

Lead II is oriented ______ to the flow of current through atria

Answer 16

Parallel

Question 17

Lead V1 is oriented _______ to electrical flow

Answer 17

Perpendicularly

Question 18

In right atrial enlargement, amplitude of the first portion of the P wave ______, _____ in width, and P wave axis may shift _______

Answer 18

Increases
No change
Rightward, beyond 90

Question 19

Right atrial enlargement is often called

Answer 19

P pulmonale

Question 20

Left atrial enlargement is called

Answer 20

P mitrale

Mitral valve disease is a common cause

Question 21

The second portion of the P wave may increase in amplitude during

Answer 21

Left atrial enlargement

Increase in P wave duration

Question 22

In left atrial enlargement, the terminal portion of the P wave should

Answer 22

Drop at least 1 mm below baseline in V1

Increase by at least .04 sec in duration

Question 23

Causes of RVH?

Answer 23

Pulm HTN
Tetrology of Fallot
Pulm valve stenosis
Ventricular septal defect
Pulm disease

Question 24

Why does RVH cause an electrical axis > 100 and right axis deviation?

Answer 24

It is reflective of the new electrical dominance of the usually "submissive" right ventricle

Question 25

In RVH, lead I is slightly more

Answer 25

Negative than positive

Question 26

No R wave progression In V1, the R wave is larger than the S wave In v6, the S wave is larger than the R wave

Answer 26

RVH

Question 27

Causes of LVH?

Answer 27

Hypertension Aortic stenosis Athleticism Hypertrophic cardiomyopathy

Question 28

Left axis deviation in the limb leads can represent LVH but it is

Answer 28

Not very useful

Question 29

Which criteria of LVH is the most accurate and sensitive?

Answer 29

R wave in aVL > 14 mm These are the others: R wave in aVF > 21 mm R wave in lead I > 14 mm R wave in lead I plus S wave in lead III > 25

Question 30

In LVH, increased ____ amplitude over leads overlaying left ventricle

Answer 30

R wave

Question 31

In LVH, increased _____ amplitude in leads overlying the right ventricle

Answer 31

S wave

Question 32

Which criteria of LVH is the most selective and accurate?

Answer 32

R wave in V5 or V6 plus S wave in V1 or v2 exceeds 35 mm Others: R wave in V5 > 26 mm R wave in V6 > 18 mm R wave in V6 exceeds R wave in V5

Question 33

Global hypertrophy can cause ______ ST segment and T wave

Answer 33

Downsloping | Inversion