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[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Valvular heart disease]]
[[Category:Congenital heart disease]]
[[Category:Cardiac surgery]]
[[Category:Surgery]]
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Revision as of 16:04, 15 August 2012

Aortic Stenosis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Mohammed A. Sbeih, M.D. [2]; Lakshmi Gopalakrishnan, M.B.B.S. [3]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [4]

Overview

The electrocardiogram in the patient with moderate to severe aortic stenosis may reveal left ventricular hypertrophy and heart block.

Electrocardiogram

  • Progressive concentric hypertrophy of the left ventricular wall may lead to larger QRS complexes, especially observed in leads V1-V6. The S wave in V1 is deep, the R wave in V4 is high. Often some ST depression can be seen in leads V5-V6, which is in this setting is called a left ventricular strain pattern.

EKG Criteria for LVH

  • Sokolow-Lyon criteria:
  • R in V5 or V6 + S in V1 >35 mm.
  • Other criteria:
  • R >26 mm in V5 or V6.
  • R >20 mm in I, II or III.
  • R >12 mm in aVL (in the absence of left anterior fascicular block).
  • Cornell-criteria has different values in men and women:
  • R in aVL and S in V3 >28 mm in men
  • R in aVL and S in V3 >20 mm in women
  • In the Romhilt-Estes Score,[1]
  • LVH is likely with 4 or more points and
  • LVH is present with 5 or more points [2].

Examples of EKG Findings in patients with AS

Left Ventricular Hypertrophy
LVH-ECG
LVH-ECG


Severe LVH in a patient with Severe Aortic Stenosis
Example of severe left ventricular hypertrophy in a patient with severe aortic valve stenosis.
Example of severe left ventricular hypertrophy in a patient with severe aortic valve stenosis.


Patient with LVH and Subendocardial Ischemia
EKG of a patient with LVH and subendocardial ischemia leading to positive cardiovascular markers in blood testing.
EKG of a patient with LVH and subendocardial ischemia leading to positive cardiovascular markers in blood testing.


LVH & Left Ventricular Strain Pattern
Left ventricular hypertrophy; left ventricular strain due to aortic stenosis.
Left ventricular hypertrophy; left ventricular strain due to aortic stenosis.


References

  1. Romhilt DW, Bove KE, Norris RJ, Conyers E, Conradi S, Rowlands DT; et al. (1969). "A critical appraisal of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy". Circulation. 40 (2): 185–95. PMID 4240354.
  2. Romhilt DW, Estes EH (1968). "A point-score system for the ECG diagnosis of left ventricular hypertrophy". Am Heart J. 75 (6): 752–8. PMID 4231231.

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