ecg in congenital heart disease
DESCRIPTION
ECG in congenital heart diseasesTRANSCRIPT
![Page 1: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/1.jpg)
ECG IN CONGENITAL HEART DISEASE
![Page 2: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/2.jpg)
LEAVE SOME SPACE FOR GREEN
![Page 3: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/3.jpg)
![Page 4: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/4.jpg)
ECG IN CHD
• ACYANOTIC CHD
• CYANOTIC CHD
![Page 5: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/5.jpg)
AcyanoticCHD
Without shunt(normal or decreased pulmonary flow)
Right side of heart
Left side of heart
↑ PBF
AtrialVentricularAortic root
right side of heartAortopulmonary level
![Page 6: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/6.jpg)
II° ASD• Sinus arrhythmia
• Clockwise loop with vertical axis
• Right axis with PAH
• Left-axis deviation : Holt-Oram syndrome/LAHB
• RAE
• P wave axis-inferior and to left with upright p in inferior leads
• PR interval:may be prolonged,intra-atrial/H-V conduction delay-first-degree AV block
![Page 7: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/7.jpg)
• Wide QRS
• RBBB
• R’ In v1 and AVR is slurred
•Crochetage-specific for ASD if present in all
inferior leads
• SND occurs as early as 2 years of age
• Atrial fibrillation,Atrial flutter
• PAT
![Page 8: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/8.jpg)
CROCHETAGE SIGN:R WAVE NOTCH IN ALL INFERIOR LEADS
![Page 9: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/9.jpg)
FOLLOW UP
• PAH
rsR’ gives way to R in v1
Signs of PAH: RAD/RVH
• After surgery R may revert to rsR’ in 40% of patients
![Page 10: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/10.jpg)
ORIGINAL AND MODIFIED METHODS OF DEFINING THE BUTLER-LEGGETT SCORE
![Page 11: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/11.jpg)
I°ASD• Counterclockwise loop
• LAD
• PR prolongation
• RVH- tall R in v1,deep s in v6
• Left A-V valve regurgitation:LVH
• Notching of s wave upstrokes in inferior leads
![Page 12: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/12.jpg)
I° ASD
![Page 13: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/13.jpg)
![Page 14: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/14.jpg)
![Page 15: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/15.jpg)
ASD ALOGARITHM
A S D
Clockwise loop
II° ASD P -wave axis normal
Crochetage+
SV ASDP- wave axis superior
Crochetage+
CounterclockwiseLoop
I° ASDLAD/Notching of s in inf leads
LVH/LAE
![Page 16: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/16.jpg)
VSD
•Location
•Hemodynamic burden
•Associated anomalies
•Typical features
LV volume overload
Progressing to BVH
![Page 17: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/17.jpg)
LOCATION
PERIMEMBRANOUS VSD
INLET VSD MULTIPLE VSD
With septal aneurysm-left axis deviation
Counterclockwise loop, LAD and prolonged PR interval
Clockwise loop with left axis deviation
![Page 18: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/18.jpg)
HEMODYNAMICS
• Accurately reflects underlying hemodynamics
• Restrictive & small-no changes
• Deep s in right precordial leads,R in v5,v6-lv volume overload
• Moderately restrictive-LVH+LAE
• Non restrictive-BVH and Katz -Wetchel,RAD
• EISENMENGER-Moderately peaked p waves,RAD,tall monophasic R in v1,deep S in left precordial leads
![Page 19: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/19.jpg)
![Page 20: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/20.jpg)
![Page 21: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/21.jpg)
![Page 22: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/22.jpg)
ASSOCIATED ANAMOLIES• PS-early transition
• AR-marked LVH in presence of restrictive VSD-DEEP Tall Deeply inverted T and coved ST segments in left precordial leads
• DORV,L-TGA-Similar to VSD
![Page 23: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/23.jpg)
![Page 24: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/24.jpg)
CONDUCTION DEFECTS• PR prolongation
Inlet VSD
ECDS
DORV
L-TGA
• Septal aneurysm-AF,AFLU,PAT,CHB/Axis change
• POST OP-RBBB(ventricular approach)
![Page 25: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/25.jpg)
GERBODES’ DEFECT• Tall peaked p waves and RAE from infancy,
• PR prolongation
• rsr’ in v1,terminal r in avr and V3r –RV volume overload
• LV volume overload
• Increased incidence of arrhythmias
• Pathognomonic-RAE with LV volume overload
![Page 26: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/26.jpg)
![Page 27: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/27.jpg)
CONGENITALLY CORRECTED TRANSPOSITION
![Page 28: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/28.jpg)
• The AV node is displaced outside of Koch’s triangle, anterior and slightly more laterally
• An elongated His bundle extends toward the site of fibrous continuity between the right-sided mitral valve and pulmonary artery(posterior)
• It courses across the anterior rim of the pulmonary valve and continues along the superior border of VSD
![Page 29: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/29.jpg)
• Conduction system
• QRS patterns
• Modifications of P,QRS,ST,T segments
![Page 30: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/30.jpg)
TYPICAL • Reversal of the normal Q-wave pattern in the precordial leads:
Q waves are present in the right precordial leads but are absent in the left precordial leads
• Clockwise loop
• Left axis deviation
• Upright T waves in all precordial leads –side by side orientation of both ventricles
![Page 31: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/31.jpg)
![Page 32: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/32.jpg)
• 75% have AV conduction abnormalties
• 30% have complete heart block
• Incidence of complete heart block increases by 2% /yr
• Long bundle length –difficult to localise site of block
• Sub pulmonic stenosis develops-axis will be right
• In even in prescence of left AV valve regurgitation and volume overload-no Q waves in left precordial leads
![Page 33: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/33.jpg)
![Page 34: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/34.jpg)
![Page 35: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/35.jpg)
VSD
LEFT AXIS
Clockwise loop-L-TGA
MULTIPLE MUSCULAR
Counter clockwise-DORV
INLET VSDTRICUSPID ATRESIA
RAD
Severe PAH
![Page 36: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/36.jpg)
VSD
LVH
MODERATELY RESTRICTIVE
WITH RAE-GERBODES
BVH
NONRESTRICTIVE
![Page 37: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/37.jpg)
NONRESTRICTIVE-BVH
Q IN LATERAL LEADS
PRESENT-simple VSD
ABSENT-LTGA
![Page 38: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/38.jpg)
PDA• SIMILAR TO VSD
• QRS axis
• RAD- infants with respiratory distress
• Superior/extreme left-Rubella syndrome
![Page 39: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/39.jpg)
AP WINDOW• SIMILAR TO non restrictive VSD
![Page 40: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/40.jpg)
D-MALPOSED GA• P wave abnormality- if RA recieves shunt or TR develops
• PR prolongation is seen
• CHB can develop
• QRS axis is normal or rightward
• All 4 chambers enlarged-into RA
• RVH,LAE,LVH-into RV
• Only LA,LV-rupture into LA
• LVH is seen,RVH is seen ,but it occyurs alone it is due to RVOT obstruction by unruptured aneurysm
![Page 41: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/41.jpg)
![Page 42: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/42.jpg)
WITHOUT SHUNT: NORMAL OR DECREASED PULMONARY FLOW
• Right side of heart
Valvular PS
DCRV
Peripheral PS
![Page 43: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/43.jpg)
VALVULAR PSTall monophasic R or qR in v1
Right axis deviation
Strain pattern in right precordial leads
![Page 44: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/44.jpg)
SEVERITY OF PS
MILD MODERATE SEVERE
Normal in 30%-60% of cases
Right axis deviation<100°
R in v1<10-15mm Upright right precordial T
waves after 4 days of age maybe only sign
Gradient of 40mm mmHg RVSP<50% of LVSP
r/s in v1>4:1 rsR’ or a small r is
present on upstroke of R’ R in v1 <20mm 50%-upright T aves Gradient>40 mm Hg RVSP>50% of LVSP
RAD>150° Monophasic R or Qr R >20mm P in lead 2 tall and
peaked,in v1 terminal force is written by right atrial dilatation
P maybe negative RVSP=LVSP or more Gradient >80 mm Hg Deep inverted T
waves ,ST depression beyond v2 and R in v1 >20mm-RVSP>LVSP
![Page 45: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/45.jpg)
![Page 46: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/46.jpg)
![Page 47: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/47.jpg)
![Page 48: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/48.jpg)
![Page 49: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/49.jpg)
PS SPECIAL
• PS with extreme right axis deviation with splintered QRS and QS in inferior leads-dysplastic PS of Noonan syndrome.
• Infants with severe stenosis, in whom the right ventricle may be hypoplastic, have a more leftward axis than expected (in the range of +30 to +70 degrees) as well as evidence of left ventricular hypertrophy
![Page 50: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/50.jpg)
![Page 51: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/51.jpg)
![Page 52: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/52.jpg)
DCRV
• RVH can be present
• But in 40% of cases upright T in v3R can be the only finding
![Page 53: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/53.jpg)
ASD WITH PS
• Non restrictive ASD and mild PS
• like ASD
• RVH will be disproportionate
• QRS axis is vertical or rightward
• rsR’ in v1-R’will be taller than that due to isolated ASD
• Severe PS with PFO-resembles isolated severe PS
![Page 54: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/54.jpg)
NORMAL OR ↓ PBF
• Left side of heart
Coarctation of aorta
Cortriatriatum
Congenital MS
Congenital AS
![Page 55: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/55.jpg)
COARCTATION
• LAE in adults, LVH-tall R waves and low flat inverted T waves
• Deeply coved ST segments-AS –bicuspid aortic valve
• Q waves in left precordial leads suggests AR
• Symptomatic infants-RAE ,RAD with RVH
• LV strain pattern in infancy is indication for surgery
![Page 56: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/56.jpg)
![Page 57: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/57.jpg)
![Page 58: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/58.jpg)
![Page 59: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/59.jpg)
INTERRUPTION OF AORTIC ARCH
• Peaked right atrial p waves and RVH-infants
• BVH gradually develops
![Page 60: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/60.jpg)
COR TRIATRIATUM
![Page 61: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/61.jpg)
SHONES COMPLEX
![Page 62: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/62.jpg)
ALOGARITHM FOR ACYANOTIC CHD:STEP I
• Which chamber is enlarged
• Step -2-suppose it is RV
• Step-3-is it volume overload(rsr’/rsR’)or pressure overload(monophasic R/qR)
• Step-4-volume overload-ASD/RSOV
• Pressure overload-PS
DCRV
Infantile coarctation
• Cortriatriatum-broad left atrial P waves
• Cogenital MS-LAE
![Page 63: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/63.jpg)
STEP II
Suppose it is LV
Is it LVH alone/BVH?
LVH alone?
volume/pressure?
volume overload Moderately restrictive VSD
PDA
Pressure overload Coarctation of aorta
Congenital AS
Interrupted .aortic arch
Critical PS of infancy
![Page 64: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/64.jpg)
• BVH
Nonrestrictive VSD
Large PDA
AP window
RSOV
L-TGA
• q in lateral leads/v1 : lateral leads-simple VSD,PDA,RSOV
• q in v1,2:L TGA
• RA enlargement is present-RSOV
![Page 65: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/65.jpg)
DORV
![Page 66: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/66.jpg)
DORV
• Left axis deviation with counter clockwise loop
• QRS duration is normal
• RVH is obligatory-tall R in v1
• Deep s in V6
• LV volume overload –tall RS complexes in mid precordial leads and tall R in v5/v6
• PAH-clockwise loop with right axis deviation
![Page 67: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/67.jpg)
![Page 68: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/68.jpg)
![Page 69: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/69.jpg)
CYANOTIC AND ↑ PBF
Transposition physiology
D-TGA
• D-TGA nonrestrictive VSD with tricuspid atresia
• DORV with sub pulmonary VSD with NO PS
• Tausig Bing
• Admixture physiology
Common atrium
Truncus arteriosus
TAPVC
![Page 70: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/70.jpg)
CYANOTIC AND ↓ PBF
• Dominant LV
Tricuspid atresia
Ebstein’ anomaly
Single ventricle –LV type with PS
• TGA (VSD and LVOTO), with restricted PBF
• TGA (VSD and PVOD), with restricted PBF
![Page 71: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/71.jpg)
CYANOTIC AND ↑ PBF
• D-TGA: conal inversion
• right and anterior aorta
• TGA (IVS or small VSD) with increased PBF and small ICSa
• TGA (VSD large) with increased PBF and large ICS
• TGA (VSD and LVOTO), with restricted PBF
• TGA (VSD and PVOD), with restricted PBF
![Page 72: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/72.jpg)
• Typical feature is RAD with RVH/BVH
• one third of infants with large VSD have normal QRS axis for age.
• Left-axis deviation - typical in TGA with AV canal types of VSD
![Page 73: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/73.jpg)
TGA WITH NON RESTRICTIVE ASD• Initial normal ECG
• Developing into RAD with RVH
• LV not prominent
![Page 74: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/74.jpg)
![Page 75: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/75.jpg)
TGA NONRESTRICTIVE VSD• RAD
• Biventricular hypertrophy
• As PAH increases it evolves into pure RVH
![Page 76: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/76.jpg)
![Page 77: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/77.jpg)
![Page 78: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/78.jpg)
![Page 79: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/79.jpg)
TGA WITH SUB PULMONIC OBSTRUCTION
• Pure RAD with RVH
![Page 80: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/80.jpg)
![Page 81: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/81.jpg)
DORV WITH SUB AORTIC VSD WITH PS
• Peaked right atrial P waves
• Right ventricular hypertrophy
• Important
• Distinction from TOF is presence of counterclockwise loop with slurred s in v5,6,1,avl and broad R in avr and presence of PR prolongation
![Page 82: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/82.jpg)
![Page 83: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/83.jpg)
![Page 84: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/84.jpg)
TAUSSIG BING ANAMOLY
![Page 85: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/85.jpg)
TRUNCUS
• Tall peaked right atrial p waves
• Bifid left atrial p waves
• Left axis deviation-increased pulmonary blood flow
• Right axis deviation-decreased pulmonary blood flow
• Biventricular hypertrophy
![Page 86: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/86.jpg)
![Page 87: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/87.jpg)
COMMON ATRIUM
![Page 88: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/88.jpg)
TAPVC
• Resembles secundum ASD
• Vertical/right axis
• RVH-common feature
• RAE-present only in non obstructive type
![Page 89: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/89.jpg)
![Page 90: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/90.jpg)
![Page 91: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/91.jpg)
TRICUSPID ATRESIA
![Page 92: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/92.jpg)
VAN PRAAGH AND ASSOCIATES- 1971
tricuspid atresia First classification
morphology of the tricuspid valve
(a) muscular type, (b) fibrous (membranous) type, and (c) Ebstein’s type
modified by him”’ and by Weinberg
muscular type constituted 84%
membranous type n 8%
The Ebstein’s type in 8%
![Page 93: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/93.jpg)
TRIUSPID ATRESIA BY KUHNE
![Page 94: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/94.jpg)
ECG
• Cyanotic child
• LAD
• Left ventricular hypertrophy
• Type1- adult pattern of progression
• RAE
![Page 95: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/95.jpg)
![Page 96: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/96.jpg)
TYPE -2• Usually non restrictive VSD
• Normal or vertical axis
• LAE and RAE
![Page 97: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/97.jpg)
![Page 98: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/98.jpg)
HYPOPLASTIC LEFT HEART• Always RVH
• qR pattern
• Left precordial R waves are diminutive
• Deep S waves are usually seen in lead V6
• Right atrial enlargement
• Right axis deviation
• ST segment changes may reflect inadequate coronary perfusion from restriction of
retrograde flow through a hypoplastic ascending
aortic arch
![Page 99: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/99.jpg)
SINGLE VENTRICLE• BVH common
• RVH
• LVH
• Stereotype QRS
![Page 100: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/100.jpg)
90% ARE LV MORPHOLOGY INVERTED OUT LEFT CHAMBER
Non inverted outlet chamber include left axis deviation, left ventricular hypertrophy, QRS complexes of great amplitude, and stereotyped precordial patterns
Inverted outlet chamber include PR interval prolongation, an inferior or rightward QRS axis, absent left precordial Q waves, RS complexes of great amplitude, and stereotyped precordial patterns
Right ventricular morphology:Precordial QRS complexes are stereotyped with right ventricular hypertrophy patterns of increased amplitude
![Page 101: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/101.jpg)
BVH
• Biventricular Hypertrophy (difficult ECG diagnosis to make)
• R/S ratio in V5 or V6 < 1
• S in V5 or V6 > 6 mm
• RAD (> 90 degrees)
![Page 102: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/102.jpg)
ESTES CRITERIA FOR LVH>5 SURE,>4 PROBABLY
![Page 103: Ecg in congenital heart disease](https://reader038.vdocuments.net/reader038/viewer/2022102422/554b3c34b4c9054b5e8b45a3/html5/thumbnails/103.jpg)
I AM NOT BE 100% ENTERTAINING