Ventricular Hypertrophy Flashcard

C. Rationale: ST depression and T wave inversion are commonly seen in LVH, particularly in the limb leads and precordial leads where tall R-waves are seen. Some interpreters refer to this morphology as left ventricular strain pattern, but it is more correctly termed LVH with associated ST-T wave abnormalities. This change is caused by altered repolarization of the hypertrophied left ventricular myocardium, or it can be related to subendocardial ischemia.

Answer choice A – Left ventricular strain is not caused by a block in conduction.
Answer choice B – Left ventricular strain is not caused by the presence of an ectopic focus.
Answer choice D – Left ventricular strain is not caused by hyponatremia.

C. Rationale: In patients with right ventricular hypertrophy without right ventricular conduction disturbances, the presence of a qR complex in precordial lead V1 (region of the right ventricle) is indicative of right ventricular overload. The Q-wave in this instance corresponds to RVH and dilatation of the right atrium and right ventricle and not a finding of an old anteroseptal infarct or necrosis.
Right ventricular infarction/ischemia would manifest as ECG changes in lead V4R.

D. Rationale: The accuracy of the Cornell index, RaVL + SV3 ≥ 28 mm in men and ≥ 20 mm in women, has a specificity of 80–90% and a sensitivity of 30%. In practice, using both the Cornell index and the Sokolow index is the recommended approach for diagnosing left ventricular hypertrophy due to high specificity. False positives are common in young or thin individuals that may have voltages exceeding the conventional ECG findings. Increased voltage is seen in athletes and is a normal variant in these patients. False negatives can be seen in patients with right bundle branch block, obesity, or COPD.

B. Rationale: Literature in ECG interpretation has devised different definitions and nomenclature. Left atrial enlargement is the same as P mitrale. Right atrial enlargement is represented by P pulmonale, and enlargement of both atriums is represented by P bitrale.

A. Rationale: P pulmonale refers to an abnormal increase in mass of the right atrium. Pathologic P pulmonale is a rare occurrence that can be found in patients with chronic obstructive pulmonary disease. It can also be a normal variant if seen in lead II in young athletic patients or patients with elevated sympathetic tone.

C. Rationale: The right ventricle is the most commonly affected by heart disease. In those 50 years and older, at least 20% or more will have left ventricular hypertrophy. Studies have shown that left ventricular hypertrophy is an independent predictor of premature death. This finding is attributed to malignant ventricular arrhythmia and heart failure.

B. Rationale: Of the choices above, the 2D echocardiogram is most suited for diagnosing anatomical abnormalities of the heart. such as biventricular hypertrophy. The diagnosis is made when the right ventricle is more enlarged than the left ventricle.

Answer choice A – A chest X-ray with a PA view displays the lungs, mediastinum, and great vessels.
Answer choice C – A cardiac MRI is helpful for diagnosing coronary artery disease, pericardial disease, tumors, and cardiomyopathy.
Answer choice D – Auscultation of a heart murmur typically indicates a valvular issue.

C. Rationale: Right axis deviation usually represents lung disease, not left ventricular hypertrophy.

Answer choices A, B, and D – Left ventricular hypertrophy manifests five major changes in its ECG characteristics: increased QRS voltage, increased QRS duration, left axis deviation, repolarization (ST-T) changes, and left atrial abnormalities.

C. Rationale: Patients with concomitant left atrial abnormality (in lieu of LVH) will have an increased duration of the P wave (≥ 0.12) in the limb leads and/or biphasic P waves with a prominent negative terminal component in V1. These subtle findings are important and a major clue to severe mitral regurgitation or dilated cardiomyopathy. Broad P waves are indicative of intra-atrial conduction delays. The presence of these atrial abnormalities can also aid in the detection of LVH in cases of concomitant left bundle branch block.

B. Rationale: For patients with RVH and RBBB (rsR’ pattern in lead V1), the pathophysiology of cor pulmonale is pulmonary hypertension. These patients usually have COPD.