ECG:

Dilated and Hyperthrophied

Dr. Hadi Purnomo, SpJP (K)

INTRODUCTION
Dilatation of
heart chamber

Heart muscle is
Cardiac stretched and the
enlargement chamber becomes
enlarged
Hypertrophy of
heart muscle

Heart muscle fibers  increase

in size  increase in the voltage
or duration od P wave or QRS
complex
 RIGHT ATRIAL ABNORMALITY
Normally, at rest, the P wave in every lead < 2.5 mm (0.25 mV)
in amplitude and < 0.12 sec (three small boxes) in width.
RAA  deep (negative) but narrow P wave in Lead V1 (width
of P wave is normal)

Abnormal P wave  P Pulmonale

 CLINICAL SIGNIFICANCE

Acute (bronchial asthma, pulmonary

embolism)
Pulmonary
disease
Chronic (emphysema, bronchitis)

• Pulmonary valve stenosis

Congenital • Atrial septal defects
heart disease • Ebstein’s anomaly (a malformation of
the tricuspid valve)
• Tetralogy of Fallot
 LEFT ATRIAL
ABNORMALITY
Left atrial enlargement  prolong the total duration of atrial
depolarization, indicated by an abnormally wide P wave with
duration of ≥0.12 sec

P wave  a distinctive humped or notched appearance (best seen

in one or more of the extremity leads)  P Mitrale
Lead V1  a distinctive biphasic P wave (a small, initial positive
deflection and a prominent, wide negative deflection)
 CLINICAL SIGNIFICANCE

 The ECG features of left atrial abnormality are associated

with more severe left ventricular dysfunction in ischemic
heart disease
 More severe valve damage in patient with mitral or aortic
valve disease
 Higher incidence of atrial tachyarrhytmia including atrial
fibrillation
 BIATRIAL ABNORMALITY

 Patient with this abnormalities can have ECG patterns

reflecting each defect
RIGHT VENTRICULAR
HYPERTROPHY
 Common Diagnoses Criteria for RVH

Mostly found in moderate to severe concentric RVH

 CLINICAL SIGNIFICANCE
 Evidence of true RVH includes:
 Right axis deviation more positive than 110 degrees
 Deep S waves in the lateral precordial leads
 An S1Q3T3 pattern, with an S wave in lead I (as an RS or rS
complex), an abnormal Q wave in lead III, and an inverted T
wave in the inferior leads.
 Pulmonary embolism acute right ventricular pressure
overload
LEFT VENTRICULAR
HYPERTROPHY
Common Diagnoses Criteria for LVH
 Bioelectrical
Structural Biochemical
changes

Higher voltage
Notch QRS ST-T
and QRS
complex abnormalities
prolongation
CLINICAL SIGNIFICANCE

Detect hypertrophy, assess prognosis, an

monitor progression or regression of
hypertrophy during treatment
 BIVENTRICULAR HYPERTROPHY
 The effects of enlargement of one chamber may
cancel the effects of enlargement of the other.
 ECG patterns usually  modification of the features
of LVH:
 Tall R waves in the right and left precordial leads
 Vertical heart position or RAD
 Deep s wave in the precordial leads
 A shift in the precordial zone to the left
 All with the evidence ofLVH
Terima Kasih