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• LVH & PVCs: Precordial Leads-KH


II

V1

• Left Atrial Enlargement-KH
• Left atrial enlargement is illustrated by increased P wave duration in lead II, top
ECG, and by the prominent negative P terminal force in lead V1, bottom tracing


• LVH - Best seen in the frontal plane leads!-KH
Lewis Index:
1) R in aVL >11 mm
2) R in I + S in III >25mm
3) (RI+SIII) - (RIII+SI) >17mm


• Right Atrial Enlargement (RAE) & Right
Ventricular Hypertrophy (RVH)-KH
• RAE is recognized by the tall (>2.5mm) P waves in leads II, III, aVF. RVH
is likely because of right axis deviation (+100 degrees)


Left Atrial Abnormality & 1st degree AV Block-KH
Sóng P rộng (>0,12s) và có khía ở DII, DIII; hai pha ở chuyển đạo V1 Tất cả các tiêu
chuẩn cho nhĩ trái không bình thờng hoặc dầy nhĩ (LAE). Khoảng PR > 0,2s: Block AV

cấp I.


• Severe RVH
- Trôc P râ (+150 degrees)
- D¹ng qR ë V1, R/S ë V1 > 1; S/R ë V6 > 1
- ST chªnh dèc xuèng ë c¸c chuyÓn ®¹o tríc tim
ph¶i


• LVH: Limb Lead Criteria-KH
• In this example of LVH, the precordial leads don't meet the usual voltage criteria or
exhibit significant ST segment abnormalities. The frontal plane leads, however,
show voltage criteria for LVH and significant ST segment depression in leads with
tall R waves. The voltage criteria include 1) R in aVL >11 mm; 2) R in I + S in
III >25mm; and 3) (RI+SIII) - (RIII+SI) >17mm (Lewis Index).


• Left Atrial Enlargement: Leads II and V1-KH


• RAE & RVH-KH


• Left Atrial Abnormality & 1st Degree AV Block: Leads
II and V1-KH
- P > 0,12s vµ cã khÝa ë DII; hai pha ë chuyÓn ®¹o V1
- Kho¶ng PR > 0,2s

• Left Atrial Enlargement & Nonspecific ST-T Wave
Abnormalities-KH
• LAE is best seen in V1 with a prominent negative (posterior) component measuring
1mm wide and 1mm deep. There are also diffuse nonspecific ST-T wave abnormalities
which must be correlated with the patient's clinical status. Poor R wave progression in
leads V1-V3, another nonspecific finding, is also present


• LVH and Many PVCs-KH
• The combination of voltage criteria (SV2 + RV6 >35mm) and ST-T
abnormalities in V5-6 are definitive for LVH. There may also be LAE as
evidenced by the prominent negative P terminal force in lead V1. Isolated
PVCs and a PVC couplet are also present.


•

Right Axis Deviation & RAE (P Pulmonale): Leads I, II, III-KH


• LVH: Limb Lead Criteria-KH
Lewis Index:

1) R in aVL >11 mm
2) R in I + S in III >25mm
3) (RI+SIII) - (RIII+SI) >17mm


• LVH: Strain pattern + Left Atrial Enlargement-KH
- SV2 + RV5 >35mm

- Sãng P réng (>0.12s) vµ cã khÝa ë DII, DIII; hai pha ë
chuyÓn ®¹o V1


• RVH with Right Axis Deviation
• Note the qR pattern in right precordial leads. This suggests right
ventricular pressures greater than left ventricular pressures. The persistent
S waves in lateral precordial leads and the RAD are other finding in RVH.


• LVH with "Strain"-KH
- SV2 + RV5 >35mm
- Lewis Index:
1) R in aVL >11 mm
2) R in I + S in III >25mm
3) (RI+SIII) - (RIII+SI) >17mm


• Right Ventricular Hypertrophy (RVH) & Right
Atrial Enlargement (RAE)-KH
• In this case of severe pulmonary hypertension, RVH is recognized by the
prominent anterior forces (tall R waves in V1-2), right axis deviation (+110
degrees), and "P pulmonale" (i.e., right atrial enlargement). RAE is best seen
in the frontal plane leads; the P waves in lead II are >2.5mm in amplitude


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