Thread by @akhadilkarMD

One of the most important diagnostic tests in Cardiology to interpret is the EKG.

Here are my thoughts and notes. Will continue to this thread. Let me know what you think!

Thread #6: Atrial Abnormality

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG

Atrial and Ventricular Enlargement:
- Both dilation & hypertrophy usually result in chronic pressure and volume overload on the heart muscle

- Pathological hypertrophy & dilation are often accompanied by fibrosis (scarring); can lead to arrhythmias and heart failure.

Right Atrial Abnormality (RAA):
- Overload of RA (dilation/ hypertrophy) may increase P-wave voltage

- Normal P-wave < 2.5 mm amplitude and < 0.12 seconds in width

- Tall, narrow P-waves: characteristic of RAA and can be best seen in II, III, aVF

Causes of RAA:
- Pulmonary disease: asthma, PE, emphysema, bronchitis

- Congenital heart disease: Pulmonary valve stenosis, atrial septal defect, Ebstein's anomaly, malformation of tricuspid valve, tetralogy of Fallot

Left Atrial Abnormality (LAA):
- Normally, the LA depolarizes after the RA
- LA enlargement is associated with prolongation of of total duration of the atrial depolarization (>0.12 sec)
- Can have a distinctive hump or notched appearance
- P-mitrale: Rheumatic heart disease

Left Atrial Abnormality:
- Lead V1 can sometimes show a distinctive biphasic P-wave (small, initial positive deflection followed by a prominent, wide negative deflection)
- Seen in valvular heart disease (AS, AR, MR, MS), HTN, dilated/hypertrophic cardiomyopathy, CAD

Thanks to this website for these amazing graphics:

litfl.com/right-atrial-e…
litfl.com/left-atrial-en…

Stay tuned for the next thread on ventricular hypertrophy and let me know what you think!