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Ventricular hypertrophy

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Ventricular hypertrophy produces changes in one or more of the following areas: the QRS axis, the QRS voltages, the R/S ratio or the T axis.

QRS voltages

 

Right ventricular hypertrophy 

Axis: RAD for the patients age

Voltages:

  • V4R / V1: Increased anterior forces (increased R waves greater than limits for patient’s age)
  • V5 / V6: Increased rightward forces (increased S waves greater than limits for patient’s age)

 

R/S ratio: Abnormal R/S ratio in favour of RV

  • V1, V2: R/S ratio greater than upper limits for child’s age
  • V6: R/S ratio less than 1 after one month of age

V4R, V1: upright T waves in children 3 days to 6 years (provided T is normal elsewhere ie upright in V6) – evidence alone of significant RVH

V1: q wave

 

Left ventricular hypertrophy 

Axis: LAD for the patients age (marked LAD is rare with LVH)

Voltages:

  • V4R / V1: Increased posterior forces (increased s waves greater than limits for patient’s age)
  • V5 / V6: Increased leftward forces (increased R waves greater than limits for patient’s age)

R/S ratio: Abnormal R/S ratio in favour of LV

  • V1, V2: R/S ratio less than upper limits for child’s age

V 5/6: Q wave ≥ 5mm

1 / aVF: inverted T wave (‘strain’)

 

Biventricular hypertrophy 

  • Positive voltage criteria for RVH and LVH (with normal QRS duration)
  • Positive voltage criteria for RVH or LVH and relatively large voltages for other ventricle
  • Large equiphasic QRS complexes in two or more limb leads and in mid‐precordial leads (V2‐5)

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