On the ECG diagnosis of ventricular hypertrophies

Alfredo de Micheli; Gustavo A Medrano

2002, Number 2

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Arch Cardiol Mex 2002; 72 (2)

On the ECG diagnosis of ventricular hypertrophies

Micheli A, Medrano GA

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Language: Spanish
References: 22
Page: 149-156
PDF size: 541.70 Kb.

ABSTRACT

The electrophysiological criteria for the diagnosis of ventricular hypertrophies, in the light of the sequence of ventricular depolarization and repolarization, are described. Hypertrophy of the right ventricle due to sustained systolic overloading can be global or segmental. In the first case, the magnitude and manifestation of the main vectors resulting from depolarization of this ventricle, i. e., IIs, IIr and IIIr, are increased. In the second case, the magnitude and manifestation of only some vectors resulting from its depolarization are increased; for example, vector IIr (right parietal) in the most frequent type of Fallot’s tetralogy and vector IIIr (right basal) in chronic cor pulmonale of obstructive origin. Left ventricular hypertrophy, which is generally of global type (aortic stenosis, systemic arterial hypertension), induces an increase in magnitude and manifestation of all the main vectors resulting from depolarization of this ventricle: I (first septal), II (left parietal) and III (left basal). But the left ventricular hypertrophy can also be of segmental type; for example, in idiopathic hypertrophic cardiomyopathy, in which the manifestation of an anteroseptal vector usually predominates. Biventricular hypertrophies produce different electrocardiographic patterns, depending on the preponderance of right or left electromotive ventricular forces. An example of electrocardiographic findings in biventricular hypertrophy is presented. It corresponds to an 18 year-old woman with a large patent ductus arteriosus compressing the left inferior laryngeal nerve, which produced a cardio-vocal syndrome. The patient had pulmonary and systemic hypertension and arterial hyposaturation. The surgical treatment of the patent ductus arteriosus normalized the pulmonary pressure as well as the arterial saturation.

REFERENCES

Espino Vela J, de Micheli A, Giordano M, Medrano G: Estudio de 80 casos de estenosis pulmonar con y sin defecto del tabique interventricular. Arch Inst Cardiol Mex 1961; 31(6): 791-817.
de Micheli A, Medrano GA, Giordano M, Chávez Rivera I, Heck J, Sodi Pallares D: Observations anatomiques et fonctionnelles dans la tétralogie de Fallot. Mal Cardiovasc 1965; 6(1): 79-120.
De Micheli A, Chávez Rivera I, Medrano GA, Contreras R, Martinesi L, Sodi Pallares D: Observaciones anatómicas y electrocardiográficas en la cardiopatía hipertensiva pulmonar crónica. Arch Inst Cardiol Mex 1964; 34(3): 334-351.
Sodi Pallares D: New bases of electrocardiography. St-Louis, MO. The C V Mosby Co, 1956, p. 404.
Cabrera Cosío E, Sodi Pallares D, Vizcaíno M: Bloqueo de rama izquierda y su relación con el estado del ventrículo izquierdo. Arch Inst Cardiol Mex 1947; 17(4): 458-477
Medrano GA, Brenes C, de Micheli A, Sodi Pallares D: Clinical electrocardiographic and vectorcardiographic diagnosis of the left anterior subdivision block isolated or associated with RBBB. Am Heart J 1972; 83: 447-458.
Medrano GA, Brenes C, de Micheli A, Sodi Pallares D: Clinical electrocardiographic and vectorcardiographic diagnosis of left posterior subdivision block, isolated or associated with RBBB. Am Heart J 1972; 84: 727-737.
Medrano GA, de Micheli A, Aranda A, Iturralde P: ¿Es aún válido el concepto de “salto de onda”? Arch Inst Cardiol Mex 2000; 70(1): 19-29.
Maldonado Tapia B, Calderón Colmeneros J, de Micheli A, Rijlaarsdam M, Casanova Garcés JM, Attie F, Buendía A: Aspectos electrocardiográficos y ecocardiográficos de la miocardiopatía hipertrófica en edad pediátrica. Arch Inst Cardiol Mex 2000; 70(3): 247-260.
Espino Vela J, de Micheli A, Ortega Mondragón ML, Pliego J: Valoración clínica y funcional de 116 casos de comunicación interventricular operados en el Instituto Nacional de Cardiología de México. Arch Inst Cardiol Mex 1968; 38(2): 161-186.
Mata LA, de los Ríos M, Medrano GA, Espino Vela J: Algunos aspectos electrocardiográficos de la sobrecarga diastólica extrema en la persistencia del conducto arterioso. Arch Inst Cardiol Mex 1972; 42(1): 193-205.
Wood P: The Eisenmenger syndrome or pulmonary hypertension with reversed central shunt. Br Med J 1958; 20: 701-709.
Wood P: The Eisenmenger syndrome or pulmonary hypertension with reversed central shunt. Br Med J 1958; 20: 755-762.
De Micheli A, Espino Vela J: La sindrome cardiovocale nelle cardiopatie congenite. Studio di un caso. Mal Cardiovasc 1960; 1(1): 97-113.
Espino Vela J, de Micheli A: Estudio de un caso de persistencia del ductus arteriosus con síndrome cardiovocal. Arch Inst Cardiol Mex 1961; 31(2): 235-243.
de Micheli A, Aranda A, Iturralde P, Medrano GA: The rational approach to the electrical exploration of the heart. Arch Cardiol Mex 2001; 71(1): 78-87.
Committee on Electrocardiography, American Heart Association: Recommendations for standardization of electrocardiographic and vectorcardiographic leads. Circulation 1954; 10: 564-573.
Green LS, Lux RL, Stilli D, Haws CW, Taccardi B: Fine detail in body surface potential maps: Accuracy of maps using a limited array and spatial and temporal data representation. J Electrocardiol 1987; 20: 21-26.
Medrano GA, de Micheli A, Padilla S: Correlación anatomo-vectocardiográfica en los crecimientos ventriculares de las cardiopatías congénitas. Arch Inst Cardiol Mex 1975; 45(1): 51-76.
de Micheli A, Medrano GA: Historia y perspectivas de la exploración electrovectocardiográfica. Arch Inst Cardiol Mex 1986; 56(4): 357-365.
de Micheli A, Medrano GA, Martínez Ríos MA: Observaciones electrovectocardiográficas en la persistencia del conducto arterioso. Rev Esp Cardiol 1984; 37(1): 38-46.
de Micheli A, Medrano GA: Manifestaciones electrovectocardiográficas de los crecimientos ventricular izquierdo y biventricular. Arch Inst Cardiol Mex 1988; 58(1): 67-77.