Hypertrophy

Hypertrophy-
-Refers to increase in size and muscle mass

Atrial Hypertrophy
-since the P wave denotes contraction of both atria we look at the P wave to determine hypertrophy
-Lead V1 is directly over the atria, so it is the best indicator of hypertrophy
-With atrial hypertrophy we have a biphasic P wave in V1
-If the initial component of the P wave in V1 is the largest, it is right atrial hypertrophy
-If the terminal portion of the biphasic P wave in lead V1 is large and wide, this is left atrial hypertrophy

-Right Atrial Hypertrophy

-Left Atrial Hypertrophy

Right Ventricular Hypertrophy-
-See a large R Wave in lead V1
-With RVH there is more positive deflection toward the V1 electrode and would expect the QRS complex more upright than normal
-The S wave in lead V1 is smaller than the R wave
-The R wave gets progressively smaller in leads V2-V6

Left Ventricular Hypertrophy-
-Hypertrophy of the left ventricle causes QRS complexes to be bigger in both height and depth in leads V1-V6 (chest leads)
-The S wave will be even deeper in V1
-In LVH there is a large S wave in lead V1 and large R wave in lead V5
-Lead V5 is directly over the left ventricle
-The T wave often shows inversion or asymmetry