Aortic stenosis electrocardiogram
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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
Electrocardiogram may be used as a diagnostic tool in the evaluation of aortic stenosis and reveals left ventricular hypertrophy and heart block.
Electrocardiogram
- Although there are no specific findings on the EKG, presence of left ventricular hypertrophy (LVH) secondary to chronic pressure overload on the left ventricle due to aortic stenosis is commonly observed.
- Many studies have demonstrated the prognostic consequences of presence or absence of Left ventricular hypertrophy[1][2].
- Progressive calcification of the aortic valve may extend beyond the valve and result in conduction abnormalities of the heart including heart block which may be apparent only on the EKG and remain undetectable otherwise.
- 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 strain pattern.
EKG Criteria for LVH
- To diagnose left ventricular hypertrophy on the EKG one of the following criteria should be met:
- 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,[3]
Examples of EKG Findings in patients with AS
Left Ventricular Hypertrophy
Severe LVH in a patient with Severe Aortic Stenosis
Patient with LVH and Subendocardial Ischemia
LVH & Left Ventricular Strain Pattern
References
- ↑ Sundström J, Lind L, Arnlöv J, Zethelius B, Andrén B, Lithell HO (2001). "Echocardiographic and electrocardiographic diagnoses of left ventricular hypertrophy predict mortality independently of each other in a population of elderly men". Circulation. 103 (19): 2346–51. PMID 11352882.
- ↑ Levy D, Salomon M, D'Agostino RB, Belanger AJ, Kannel WB (1994). "Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy". Circulation. 90 (4): 1786–93. PMID 7923663.
- ↑ 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.
- ↑ 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.