Pulmonic regurgitation electrocardiogram: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Pulmonic regurgitation}} | {{Pulmonic regurgitation}} | ||
{{CMG}}, {{AE}}{{AKI}}, {{AA}} | {{CMG}}, {{AE}}{{AKI}}, {{AA}}, {{JA}} | ||
==Overview== | ==Overview== | ||
[[EKG]] findings among patients wit chronic [[PR|Pulmonic regurgitation]] (PR) may be non-specific. [[Ventricular tachycardia]] is demonstrated on EKG among [[patients]] with [[PR]] and [[RV]] dilatation. [[Patients]] may develop [[atrial flutter]]/[[atrial fibrillation|fibrillation]] after years of [[PR]] development. Among patients with [[tetralogy of Fallot]] (TOF), increased [[QRS]] duration with widened [[QRS]] complex reflects the severity of [[PR]] and [[right ventricular dilation]] predisposes the [[patients]] to develop malignant [[arrythmias]]. | |||
==Electrocardiogram== | |||
===Key EKG Findings in Pulmonic regurgitation=== | |||
[[EKG]] findings among [[patients]] with [[pulmonary regurgitation]] (PR) may include the following: | |||
*[[Ventricular tachycardia]] is demonstrated on EKG among [[patients]] with [[PR]] and [[RV]] dilatation.<ref name="pmid17569817">{{cite journal |vauthors=Chaturvedi RR, Redington AN |title=Pulmonary regurgitation in congenital heart disease |journal=Heart |volume=93 |issue=7 |pages=880–9 |date=July 2007 |pmid=17569817 |pmc=1994453 |doi=10.1136/hrt.2005.075234 |url=}}</ref> (''EKG 1'') | |||
*'''Mild [[PR]]''': Signs of [[Right ventricular hypertrophy|RV hypertrophy]] may be demonstrated on [[EKG]] such as tall [[P waves]], increased [[R wave|R]] to [[S wave|S]] ratio in the right [[precordial leads]] and [[right axis deviation]] <ref name="pmid21738303">{{cite journal |vauthors=Glancy DL, Jain N, Jaligam VR, Ilie CC, Atluri P |title=Electrocardiogram in a woman with cor pulmonale |journal=Proc (Bayl Univ Med Cent) |volume=24 |issue=3 |pages=255–6 |date=July 2011 |pmid=21738303 |pmc=3124915 |doi=10.1080/08998280.2011.11928728 |url=}}</ref>: | |||
*'''Severity of [[PR]]'''<ref name="pmid24800023">{{cite journal |vauthors=Tanasan A, Kocharian A, Zanjani KS, Payravian FK, Torabian S |title=Correlation between QRS Duration, Pulmonary Insufficiency and Right Ventricle Performance in Totally Corrected Tetralogy of Fallot |journal=Iran J Pediatr |volume=23 |issue=5 |pages=593–6 |date=October 2013 |pmid=24800023 |pmc=4006512 |doi= |url=}}</ref>: A strong correlation between [[QRS]] duration and [[PR]] index has been demonstrated. [[QRS]] duration ≥160 ms predicted severe [[PR]] with 100% [[sensitivity]] and 87% [[specificity]] among [[patients]] with repaired [[TOF]] in a cohort study. | |||
*'''Chronic [[PR]]'''<ref name="pmid17569817">{{cite journal |vauthors=Chaturvedi RR, Redington AN |title=Pulmonary regurgitation in congenital heart disease |journal=Heart |volume=93 |issue=7 |pages=880–9 |date=July 2007 |pmid=17569817 |pmc=1994453 |doi=10.1136/hrt.2005.075234 |url=}}</ref><ref name="pmid7600655">{{cite journal |vauthors=Gatzoulis MA, Till JA, Somerville J, Redington AN |title=Mechanoelectrical interaction in tetralogy of Fallot. QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death |journal=Circulation |volume=92 |issue=2 |pages=231–7 |date=July 1995 |pmid=7600655 |doi=10.1161/01.cir.92.2.231 |url=}}</ref>: | |||
**EKG findings demonstrated in chronic [[PR]] are non-specific. | |||
**[[Patients]] may develop [[atrial flutter]]/[[atrial fibrillation|fibrillation]] after years of [[PR]] development. (''EKG 2'') | |||
**Due to [[PR]], chronic [[RV]] volume overload has been associated with a prolonged [[QRS]]. All [[patients]] with [[ventricular tachycardia]] or [[sudden death]] have demonstrated [[QRS]] duration of ⩾180 ms. | |||
*'''Isolated [[PR]]''': Among [[patients]] with [[RV]] [[volume overload]] and isolated [[PR]], [[QRS]] prolongation with [[rSr]] morphology can be seen in right [[precordial leads]]. | |||
*'''[[TOF]] and Post-[[TOF]] repair'''<ref name="pmid7600655">{{cite journal| author=Gatzoulis MA, Till JA, Somerville J, Redington AN| title=Mechanoelectrical interaction in tetralogy of Fallot. QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death. | journal=Circulation | year= 1995 | volume= 92 | issue= 2 | pages= 231-7 | pmid=7600655 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7600655 }}</ref><ref name="pmid10995413">{{cite journal| author=Abd El Rahman MY, Abdul-Khaliq H, Vogel M, Alexi-Meskishvili V, Gutberlet M, Lange PE| title=Relation between right ventricular enlargement, QRS duration, and right ventricular function in patients with tetralogy of Fallot and pulmonary regurgitation after surgical repair. | journal=Heart | year= 2000 | volume= 84 | issue= 4 | pages= 416-20 | pmid=10995413 | doi= | pmc=1729453 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10995413 }} </ref>: | |||
**Among patients with [[tetralogy of Fallot]] (TOF) increased [[QRS]] duration with widened [[QRS]] complex reflects the severity of [[PR]] and [[right ventricular dilation]] predisposes the [[patients]] to develop malignant [[arrythmias]]. | |||
**[[Right bundle branch block|RBB]] is common among the majority of [[patients]] who have [[tetralogy of Fallot]] repair with right ventriculotomy. (''EKG 3'') | |||
*'''[[Pulmonary hypertension]] (PAH)''': Among [[patients]] with [[PAH]], [[Right ventricular hypertrophy|RV hypertrophy]] may be demonstrated on [[EKG]] as<ref name="pmid21738303">{{cite journal |vauthors=Glancy DL, Jain N, Jaligam VR, Ilie CC, Atluri P |title=Electrocardiogram in a woman with cor pulmonale |journal=Proc (Bayl Univ Med Cent) |volume=24 |issue=3 |pages=255–6 |date=July 2011 |pmid=21738303 |pmc=3124915 |doi=10.1080/08998280.2011.11928728 |url=}}</ref>: | |||
** [[P pulmonale]] (tall [[P waves]]- demonstrating [[right atrial enlargement]], (''EKG 4'') | |||
**Increased [[R wave|R]] to [[S wave|S]] ratio in the right [[precordial leads]] | |||
**[[Right axis deviation]] | |||
==EKG examples== | |||
'''EKG1''': The EKG demonstrates [[ventricular tachycardia]] with a [[heart rate|rate]] of 150 bpm, and a [[right bundle branch block]] pattern with right [[heart axis]]. The 5th and 6th complexes from the right side are fusion complexes. Moreover, this EKG shows [[baseline drift]], which is a technical artifact. | |||
[[Image:12lead_vt3.png|center|700px]] | |||
Copyleft image obtained courtesy of ECGpedia,http://en.ecgpedia.org/wiki/Main_Page | |||
---- | |||
'''EKG 2''': The EKG demonstrates [[irregularly irregular rhythm]] with no [[P wave]]s, suggestive of [[atrial fibrillation]]. | |||
[[Image:AFIB_12.jpg|center|800px]] | |||
Copyleft image obtained courtesy of ECGpedia,http://en.ecgpedia.org/wiki/Main_Page | |||
---- | |||
'''EKG 3''': The EKG demonstrates [[ventricular tachycardia]] with a rate of 250 bpm, and a [[right bundle branch block]] pattern with a right [[heart axis]]. | |||
[[Image:12lead_vt2.png|center|800px]] | |||
Copyleft image obtained courtesy of ECGpedia,http://en.ecgpedia.org/wiki/Main_Page | |||
---- | |||
'''EKG 4''': The EKG demonstrates [[right ventricular hypertrophy]] and [[right atrial enlargement]] in a patient with [[chronic PAH]]. Note [[P pulmonale]] that is a [[P wave]] amplitude >2.5mm among inferior leads (II, III, and AVF) and [[T wave inversion]] among leads II, III, aVF, V2, V3, V4, V5. | |||
[[Image:Pulhtn1.jpg|center|700px]] | |||
Copyleft image obtained courtesy of ECGpedia,http://en.ecgpedia.org/wiki/Main_Page | |||
---- | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 20:51, 6 August 2020
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Pulmonic regurgitation Microchapters |
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Diagnosis |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2], Aysha Anwar, M.B.B.S[3], Javaria Anwer M.D.[4]
Overview
EKG findings among patients wit chronic Pulmonic regurgitation (PR) may be non-specific. Ventricular tachycardia is demonstrated on EKG among patients with PR and RV dilatation. Patients may develop atrial flutter/fibrillation after years of PR development. Among patients with tetralogy of Fallot (TOF), increased QRS duration with widened QRS complex reflects the severity of PR and right ventricular dilation predisposes the patients to develop malignant arrythmias.
Electrocardiogram
Key EKG Findings in Pulmonic regurgitation
EKG findings among patients with pulmonary regurgitation (PR) may include the following:
- Ventricular tachycardia is demonstrated on EKG among patients with PR and RV dilatation.[1] (EKG 1)
- Mild PR: Signs of RV hypertrophy may be demonstrated on EKG such as tall P waves, increased R to S ratio in the right precordial leads and right axis deviation [2]:
- Severity of PR[3]: A strong correlation between QRS duration and PR index has been demonstrated. QRS duration ≥160 ms predicted severe PR with 100% sensitivity and 87% specificity among patients with repaired TOF in a cohort study.
- Chronic PR[1][4]:
- EKG findings demonstrated in chronic PR are non-specific.
- Patients may develop atrial flutter/fibrillation after years of PR development. (EKG 2)
- Due to PR, chronic RV volume overload has been associated with a prolonged QRS. All patients with ventricular tachycardia or sudden death have demonstrated QRS duration of ⩾180 ms.
- Isolated PR: Among patients with RV volume overload and isolated PR, QRS prolongation with rSr morphology can be seen in right precordial leads.
- TOF and Post-TOF repair[4][5]:
- Among patients with tetralogy of Fallot (TOF) increased QRS duration with widened QRS complex reflects the severity of PR and right ventricular dilation predisposes the patients to develop malignant arrythmias.
- RBB is common among the majority of patients who have tetralogy of Fallot repair with right ventriculotomy. (EKG 3)
- Pulmonary hypertension (PAH): Among patients with PAH, RV hypertrophy may be demonstrated on EKG as[2]:
- P pulmonale (tall P waves- demonstrating right atrial enlargement, (EKG 4)
- Increased R to S ratio in the right precordial leads
- Right axis deviation
EKG examples
EKG1: The EKG demonstrates ventricular tachycardia with a rate of 150 bpm, and a right bundle branch block pattern with right heart axis. The 5th and 6th complexes from the right side are fusion complexes. Moreover, this EKG shows baseline drift, which is a technical artifact.
Copyleft image obtained courtesy of ECGpedia,http://en.ecgpedia.org/wiki/Main_Page
EKG 2: The EKG demonstrates irregularly irregular rhythm with no P waves, suggestive of atrial fibrillation.
Copyleft image obtained courtesy of ECGpedia,http://en.ecgpedia.org/wiki/Main_Page
EKG 3: The EKG demonstrates ventricular tachycardia with a rate of 250 bpm, and a right bundle branch block pattern with a right heart axis.
Copyleft image obtained courtesy of ECGpedia,http://en.ecgpedia.org/wiki/Main_Page
EKG 4: The EKG demonstrates right ventricular hypertrophy and right atrial enlargement in a patient with chronic PAH. Note P pulmonale that is a P wave amplitude >2.5mm among inferior leads (II, III, and AVF) and T wave inversion among leads II, III, aVF, V2, V3, V4, V5.
Copyleft image obtained courtesy of ECGpedia,http://en.ecgpedia.org/wiki/Main_Page
References
- ↑ 1.0 1.1 Chaturvedi RR, Redington AN (July 2007). "Pulmonary regurgitation in congenital heart disease". Heart. 93 (7): 880–9. doi:10.1136/hrt.2005.075234. PMC 1994453. PMID 17569817.
- ↑ 2.0 2.1 Glancy DL, Jain N, Jaligam VR, Ilie CC, Atluri P (July 2011). "Electrocardiogram in a woman with cor pulmonale". Proc (Bayl Univ Med Cent). 24 (3): 255–6. doi:10.1080/08998280.2011.11928728. PMC 3124915. PMID 21738303.
- ↑ Tanasan A, Kocharian A, Zanjani KS, Payravian FK, Torabian S (October 2013). "Correlation between QRS Duration, Pulmonary Insufficiency and Right Ventricle Performance in Totally Corrected Tetralogy of Fallot". Iran J Pediatr. 23 (5): 593–6. PMC 4006512. PMID 24800023.
- ↑ 4.0 4.1 Gatzoulis MA, Till JA, Somerville J, Redington AN (July 1995). "Mechanoelectrical interaction in tetralogy of Fallot. QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death". Circulation. 92 (2): 231–7. doi:10.1161/01.cir.92.2.231. PMID 7600655.
- ↑ Abd El Rahman MY, Abdul-Khaliq H, Vogel M, Alexi-Meskishvili V, Gutberlet M, Lange PE (2000). "Relation between right ventricular enlargement, QRS duration, and right ventricular function in patients with tetralogy of Fallot and pulmonary regurgitation after surgical repair". Heart. 84 (4): 416–20. PMC 1729453. PMID 10995413.