Performing a 12-Lead ECG

Overview

Click To Begin 12-Lead ECG Left Ventricular Hypertrophy Training

Overview

Left Ventricular Hypertrophy

Tech Series
ECG Interpretation

Thomas E. O'Brien
AS CCT CRAT RMA

Objectives

Upon completion of the accompanying narrative and practice, the student will be able to:

  • Recall the process for measurement to determine the presence of left ventricular hypertrophy
  • Apply the process for measurement to determine the presence of left ventricular hypertrophy
  • Determine whether there is electrocardiographic evidence of left ventricular hypertrophy

Analysis of ECGs

People may choose to analyze ECG’s in a number of different ways. The sequence doesn’t necessarily matter as long as you gather and report the proper information each time.

If your protocols are different, always follow them.


Left Ventricular Hypertrophy (LVH)

Intro

Hypertrophy refers to an abnormal thickening of a chamber wall.

Simply put, this abnormal thickening translates to an increase in the voltage of the QRS complex.

The wall thickens due to increased vascular resistance over time

heart with left ventricular hypertrophy

Intro 2

QRS complexes will show greater amplitude (more muscle mass = more electrical activity)

Taller and deeper ventricular depolarization waves will be seen

Remember: Hypertrophy increases voltage – BBB increases duration.


Determining LVH 1

Step 1

Determining the presence of LVH is a fairly simple and straight forward three-step process.

  • Refer to leads V1 & V2
  • Measure and select the deepest ventricular depolarization of the 2 views (not including aberrant complexes)
  • Measure from the isoelectric line down to the tip of the deepest QS complex.
  • Measure from the isoelectric line down to the tip of the deepest QS complex.
  • Write this number down

Determining LVH 2

Step 2

  • Refer to leads V5 & V6
  • Measure and select the tallest ventricular depolarization of the 2 views (not including aberrant complexes)
  • Measure from the isoelectric line up to the tip of the tallest “R” wave.
  • Count the number of millimeters (small boxes)
  • Write this number down

Determining LVH 3

Step 3

  • Add the 2 numbers together
  • If it adds up to 35mm or more, clinically you must suspect left ventricular hypertrophy

LVH Analysis

Example

  • Note the red arrows. The deepest “QS” wave from V1 and V2 has been selected
  • The tallest R wave in V5 and V6 has been selected
  • What is the total number?
  • 37 mm, YES!
lvh ecg image 1

Quick Check 1

Tracing

Quick check #1: Take measurements for LVH on this tracing, then navigate to the next tab.

lvh ecg image q1

Is LVH present?

Yes
No




Measurement

What number did you get?

A. 24 mm
B. 32 mm
C. 38 mm
D. 39 mm
E. 46 mm
F. 52 mm
G. 58 mm





Quick Check 2

Tracing

Quick check #2: On this tracing, take LVH measurements, then move to the next tab.

lvh ecg image q2

Is LVH present?

Yes
No




Measurement

What number did you get?

A. 24 mm
B. 32 mm
C. 38 mm
D. 39 mm
E. 46 mm
F. 52 mm
G. 58 mm





Quick Check 3

Tracing

Quick check #3: Using the tracing, determine LVH measurements. The navigate to the next slide.

lvh ecg image q3

Is LVH present?

Yes
No




Measurement

What number did you get?

A. 24 mm
B. 32 mm
C. 38 mm
D. 39 mm
E. 46 mm
F. 52 mm
G. 58 mm





Quick Check 4

Tracing

Quick check #4: Take LVH measurements on this practice tracing, then navigate to the next tab.

lvh ecg image q4

Is LVH present?

Yes
No




Measurement

What number did you get?

A. 24 mm
B. 32 mm
C. 38 mm
D. 39 mm
E. 46 mm
F. 52 mm
G. 58 mm





Quick Check 5

Tracing

Quick check #5: Practice taking LVH measurements on this tracing, the navigate to the next tab.

lvh ecg image q5

Is LVH present?

Yes
No




Measurement

What number did you get?

A. 24 mm
B. 32 mm
C. 38 mm
D. 39 mm
E. 46 mm
F. 52 mm
G. 58 mm