VII. Atrial
Enlargement
Topics for study:
- Right
Atrial Enlargement (RAE)
- Left
Atrial Enlargement (LAE)
- Bi-Atrial
Enlargement (BAE)
1. Right Atrial Enlargement (RAE)
P wave amplitude >2.5 mm in II and/or >1.5 mm in V1
(these criteria are not very specific or sensitive)
Better
criteria can be derived from the QRS complex; these QRS changes are due to
both the high incidence of RVH when RAE is present, and the RV displacement by
an enlarged right atrium.
QR,
Qr, qR, or qRs morphology in lead V1 (in absence of coronary heart disease)
QRS
voltage in V1 is <5 mm and V2/V1 voltage ratio is >6
(Sensitivity = 50%; Specificity = 90%)
click
here to view
In the above ECG, note the tall P waves in Lead
II, and the Qr wave in Lead V1.
2. Left Atrial Enlargement (LAE)
P wave duration > 0.12s in frontal plane (usually
lead II)
Notched P wave in limb leads with the inter-peak duration
> 0.04s
Terminal P negativity in lead V1 (i.e., "P-terminal force")
duration >0.04s, depth >1 mm.
Sensitivity = 50%; Specificity = 90%
click
here to view
3. Bi-Atrial Enlargement (BAE)
Features of both RAE and LAE in same ECG
P wave
in lead II >2.5 mm tall and >0.12s in duration
Initial positive component of P wave in V1 >1.5 mm tall
and prominent P-terminal force