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 #7: Ventricular Hypertrophy

#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 Ventricular Hypertrophy:
- Right chest leads show tall R-waves
- R-wave > S-wave in V1 is suggestive; not diagnostic of RVH
- Can see right-axis deviation and T-wave inversions in the right & mid-precordial leads
- RV hypertrophy can lead to variations in repolarization
Right Ventricular Hypertrophy:
- Factors: congenital heart diseases (pulmonary stenosis, ASD, tetralogy of Fallot, Eisenmenger's syndrome), lung disease (severe pulmonary hypertension)
- Can happen in patients with complete/incomplete RBBB pattern with RA deviation
Left Ventricular Hypertrophy (LVH):
- Normally, LV has a larger mass and is electrically dominant compared to RV
- 2 most important causes: systemic HTN & Aortic stenosis
- 3 major clinical conditions w/ LV overload: Aortic & Mitral Regurgitation, Dilated Cardiomyopathy
LVH Criteria:
- S-wave in V1 & R-wave in V5/V6 ≥ 35-mm (high voltages can be common in athletic or thin, young adults)
- Cornell voltage: S-wave in V3 + R-wave in aVL > 28-mm in men and > 20-mm in women
- R-wave > 11-13 mm in aVL
LVH:
- Strain pattern: ST-T wave changes with distinctively asymmetric appearance with slight ST-segment depression followed by broadly inverted T-wave
- Can see signs of left atrial abnormality (broad P-waves in extremity leads or wide biphasic P-waves)
Biventricular Hypertrophy:
- Present in some cases of severe dilated cardiomyopathy or rheumatic valvular disease
- Should get an ECHO to determine the presence of cardiac chamber enlargement
Thanks for this website for amazing graphics!

litfl.com/right-ventricu…
litfl.com/left-ventricul…

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

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More from @akhadilkarMD

Mar 2
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
Read 7 tweets
Feb 6
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 #5: Axis Deviation

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG
QRS Axis:
- General direction in the frontal plane towards which the QRS complex is predominantly pointed

- General rule: Mean QRS points mid-way b/w any 2 leads that show tall R-wave of equal height

- If depolarization is perpendicular to any lead, will see biphasic complex
Axis Deviation:
- For most people, the axis lies between -30 and + 100 degrees

- Left axis: < -30 degrees, lead II rS pattern (S-wave deeper than R-wave is tall)

- Right axis: > +100 degrees (R-wave in III > II)
Read 6 tweets
Feb 6
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 #4: ECG Segments

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG
General Principles:
- Positive deflection: wave of depolarization towards positive pole of that lead
- Negative deflection: wave of depolarization towards negative pole of that lead
- Biphasic deflection: wave of depolarization is perpendicular to a lead
Normal Sinus P-wave:
- Atrial depolarization that marks spontaneous depolarization of pacemakers cells in the right atrium
- Should be negative P-wave in aVR and upright in lead II
- Can communicate 'sinus rhythm with 1:1 AV conduction'
Read 7 tweets
Feb 5
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 #3: ECG Leads

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG
ECG Leads:
- Body act as a conductor of electricity; the recording electrodes in the arms, legs, and chest wall show the differences in voltage (potential) among electrodes
- Different views of the same event leads to different ECG patterns
ECG Limb Leads:
- 6 Limb leads (extremity leads) and 6 chest (precordial)
- 3 bipolar limb leads: I, II, III
- 3 augmented unipolar: aVR, aVL, and aVF
- 6 precordial leads: V1-V6
Read 7 tweets
Jan 26
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!

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG
Conduction System:
- SA node (pacemaker cells) have specialized conduction tissue
- SA node is located in the RA near the opening of the SVC
- Stimulation occurs from right atrium to left atrium
- Simultaneous atrial contractions allows for blood filling into LV and RV
Conduction:
- AV Junction: Located at the base of the inter-atrial septum and extends into the inter-ventricular septum; the proximal portion is the AV node and distal portion is bundle of His
- Left & Right Bundle branches depolarize the myocardium via Purkinje fibers
Read 9 tweets
Jan 8
As a Cardiology fellow, we get a lot of consults for hypertensive urgency/emergency.

Part 4: Clinical Consequences of Hypertensive Urgency/Emergency

-thread 🧵-

#arjuncardiology #MedTwitter #Cardiotwitter #IMG #MedEd
1) Hypertensive Encephalopathy
- Cerebral edema is induced by markedly elevated blood pressures
- Dysregulation of auto-regulatory capabilities of the brain
- Characterized by headache, irritability, and altered mental status
- Treatment of choice: Nitroprusside/Labetalol
2) Reversible Posterior Leukoencephalopathy Syndrome (PRES)
- MRI may reveal white matter edema in the parito-occipital regions
Read 9 tweets

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