Hypertension And Ventricular Hypertrophy

Question 1

What is a normal blood pressure reading?

Answer 1

120( (systolic)/80 (diastolic)

Question 2

What range of values is high blood pressure?

Answer 2

140/90

Question 3

What can HTN be a risk factor for?

Answer 3

Ischaemic and haemorrhagic stroke
MI
HF
Chronic kidney disease
Death

Question 4

What are the two forms of HTN?

Answer 4

Primary: due to genetic/ lifestyle factors

Secondary: as a result of underlying causes (cardiac problems, sleep apnoea, renal/kidney disease, thyroid dysfunction)

Question 5

Treatment options for HTN

Answer 5

• lifestyle changes
• ACE inhibitors or Ca channel blockers

Question 6

How do pathological changes occur in HTN?

Answer 6

Slowly, and it progresses to vascular remodelling. Diastolic LVHF may be the earliest detectable sequence that precedes LVH

Question 7

What is RVH?

Answer 7

Increased enlargement of the right ventricle usually due to chronic lung disease or congenital structural defects

Question 8

Causes of RVH

Answer 8

• pulmonary HTN
• increased blood pressure in blood vessels supplying blood to lungs
• mitral stenosis
• pulmonary stenosis

Question 9

What are some potential ECG changes in RVH?

Answer 9

• V1 is closest to RV so it is best places to detect the changes of RVH, so dominant R waves in V1-V2
• increased rightward forces = RAD (>90’ in limb leads)
• ST depression and T wave inversion
• potentially incomplete RBBB or qR pattern in V1
• evidence of right atrial enlargement

Question 10

How does RAE occur?

Answer 10

Chronic elevation of pulmonary vascular resistance due to … and primary HTN can result in
- RV increasing thickness to compensate = RVH
- RV tried to get stronger to push blood to lungs = less room in RV
- RV enlargement = RV dilatation
- Tricuspid annulus dilatation = valve cannot close properly
- valve leaks back into RA
- extra blood into RA from all of the body and from the leak causes RAE

Question 11

RAE on an ECG

Answer 11

Peaked p wave (P pulmonale) with amplitude:
- >2.5mm in inferior leads
- >1.5mm in V1 and V2

Question 12

What are the values for RAD?

Answer 12

• POS QRS in II, III and aVF
• Lead III has tallest QRS (not lead II)
• NEG QRS in lead I

Question 13

Criteria for RVH on ECG

Answer 13

• dominant R wave in V1 (>7mm tall)
• dominant S wave in V5/V6 (>7mm tall)
• ST depression and T wave inversion in V1-V3 and in Leads II, III and aVF (Right chest Leads and inferior leads)

Question 14

Most common causes of LVH

Answer 14

• systemic HTN is the most common cause
• aortic stenosis and coarctation of the aorta

Question 15

What is LVH?

Answer 15

A condition in which increased left ventricular mass occurs secondary to an increase in LV wall thickness, an increase in LV cavity enlargement or both

Question 16

What is LV thickness due to?

Answer 16

Pressure overload (systemic HTN/ AS), and chamber dilation due to volume overload (AR/ HF)

Question 17

What does an LVH ECG show?

Answer 17

• thickened LV wall causes prolonged depolarisation (increased R wave peak time) and delayed repolarisation (ST-T abnormalities ) in lateral leads
• usually ST depression and T wave inversion in left precordial leads with reciprocal ST elevation in right precordial leads

Question 18

LAD criteria

Answer 18

• POS QRS in Lead I and aVL
• NEG QRS in aVF, lead II and III

Question 19

LVH criteria

Answer 19

Limb leads
R wave (I) and S wave (III) >25mm
R wave in aVL>11mm
R wave in aVF> 20mm

Precordial leads
S wave (V1) and tallest R Wave (V5-V6) >35mm (Sokolov’s criteria)
R wave (V4,V5,V6) >26mm
Largest R wave and largest S wave in chest leads >45mm