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ECG Changes in various Heart diseases

Right Atrial Overload -
Leads to Increase in P wave amplitute (>2.5 mm)

Left Atrial Overload -
Produces biphasic P wave in V1 with a broad negative component or a broad notched P wave in 1 or more limb leads.(This pattern may also occur in left atrial conduction delays.)

Right ventricular Pressure overload -
Characterised by tall R wave in V1 with right axis deviation.St depression and T wave inversion in right to mideprecordial leads (Ventricular strain pattern : attributed to repolarisation abnormalities in hypertrophied muscle.) are also often present.There may be qR pattern in V1 or V3R

Right Ventricular Volume overload -
is associated with complete or incomplete right bundle branch block with rightward QRS axis deviation.

Acute Cor Pulmonale -
Most commonly due to pulmonary embolism.
QRS axis shifts to right.S1Q3T3 pattern (prominence of S wave in lead 1, Q wave in lead 3 and inversion of T wave in lead 3.

Chronic Cor Pulmonale -
Mostly due to pbstructive lung disease.
Does not ptoduce classic ECG pattern of right ventricular hypertrophy.Small R waves (poor R wave prograssion) is due to downward displacement of diaphragm and heart.

Left Ventricular hypertrophy -
Tall R waves, deep right S waves are seen.RV5 or RV6 > 25 mm
SV1+RV5 (or RV6) > 35 mm
Repolarisation abnormality - ST depresion and T wave inversion (left ventricular strain pattern) is seen.


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