ECG-2014-Pocket Brain (Expanded) by Grauer Ken

Author:Grauer, Ken [Grauer, Ken]
Language: eng
Format: epub
Publisher: KG/EKG Press
Published: 2014-01-15T14:00:00+00:00

Figure 08.19-1: ECG criteria for RAA (P pulmonale). Most commonly — ECG diagnosis of RA is made from P wave appearance in lead II (tall, peaked and pointed P wave at least 2.5 mm tall). The P wave looks, “uncomfortable to sit on”. On occasion — RAA may be suggested by the finding of a pointed positive component to the P wave in lead V1.

08.20 – ECG Diagnosis of LAA: P Mitrale

LAA (Left Atrial Abnormality) — is diagnosed by finding an m-shaped (notched) and widened P wave (≥0.12 second) in a "mitral" lead (I,II,aVL ) — and/or a deep negative component to the P wave in lead V1 = P Mitrale (Figure 08.20-1).

The reason the P wave becomes wider with LAA is that the left atrium is activated after the right atrium (since the SA Node is in the RA). It is addition of this LA component to the P wave that produces the notch/extra ‘hump’ to form the “M” in lead II.

The best ECG sign of LAA is the finding of a deep, negative component to the P wave in lead V1 — that is at least 1 little box deep or wide.

We generally undercall LAA — because of the overall poor specificity the ECG has for atrial enlargement. Remember that some negativity to the P wave in lead V1 is a normal finding! Therefore, it is best not to even contemplate an ECG diagnosis of “LAA” — unless the negative component to the P wave in lead V1 is definitely at least 1 little box deep and/or wide.

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