ECG ON CONGENITAL HEART DISEASE

1. ECG CHANGES IN RHD, MVP AND
CONGENITAL HEART DISEASES
PRESENTER: DR. AYUSHI MUNGAD
MODERATOR: DR M.K. JAIN SIR

2. RHEUMATIC HEART DISEASE
ON ECG, RHEUMATIC FEVER IS CHARACTERIZED BY :
• PR INTERVAL PROLONGATION,
• CONDUCTION ABNORMALITIES,
• ARRYHTHMIAS, OR P MITRALE
• DEPENDING ON THE STRUCTURES INVOLVED AND THE EXTENT OF
CARDIAC DAMAGE

3. • ECG CHANGES DEPEND ON THE STRUCTURES INVOLVED AND THE
EXTENT OF CARDIAC DAMAGE. THE FOLLOWING ECG CHANGES MAY BE
NOTED IN PATIENTS WITH RHEUMATIC FEVER:
• SINUS TACHYCARDIA OR BRADYCARDIA DEPENDING ON VAGAL TONE
• PROLONGATION OF PR INTERVAL
• VARIABLE DEGREE OF AV CONDUCTION BLOCK

4. • P MITRALE SECONDARY TO MITRAL VALVE ABNORMALITIES
• MITRAL VALVE ABNORMALITIES MAY LEAD TO DEVELOPMENT
OF ATRIAL FLUTTER OR ATRIAL FIBRILLATION
• T-WAVE INVERSIONS WHICH MAY BE NOTED IN LEADS I, II AND IV
SUGGESTIVE OF PERICARDIAL INVOLVEMENT.
• ST SEGMENT ELEVATION MAY ALSO BE PRESENT IN LEADS II, III, AVF
AND V4 TO V6 IN PATIENTS WITH ACUTE PERICARDITIS

6. MITRAL VALVE PROLAPSE

7. SECUNDUM ATRIAL SEPTAL DEFECT
• RHYTHM: NORMAL SINUS RHYTHM, INCREASED RISK OF AF WITH AGE
• PR INTERVAL: FIRST DEGREE AV BLOCK IN 6-19%
• QRS AXIS: 0° TO 180°; RAD; LAD IN HOLT-ORAM OR LAHB

8. SECUNDUM ATRIAL SEPTAL DEFECT
• QRS CONFIGURATION: RSR´ OR RSR´ WITH RBBBI>RBBBC
• ATRIAL ENLARGEMENT: RAE 35%
• VENTRICULAR HYPERTROPHY: UNCOMMON
• PARTICULARITIES: "CROCHETAGE" PATTERN

9. VENTRICULAR SEPTAL DEFECT
• RHYTHM: NORMAL SINUS RHYTHM, PVCS
• PR INTERVAL: NORMAL OR MILD ↑; 1° AVB 10%
• QRS AXIS: RAD WITH BVH; LAD 3% TO 15%

10. VENTRICULAR SEPTAL DEFECT
• QRS CONFIGURATION: NORMAL OR RSR´; POSSIBLE RBBB
• ATRIAL ENLARGEMENT: POSSIBLE RAE±LAE
• VENTRICULAR HYPERTROPHY: BVH 23% TO 61%; RVH WITH
EISENMENGER
• PARTICULARITIES: KATZ-WACHTEL PHENOMENON

11. PATENT DUCTUS ARTERIOSUS
• RHYTHM: NORMAL SINUS RHYTHM, ↑ IART/AF WITH AGE
• PR INTERVAL: ↑ PR 10% TO 20%
• QRS AXIS: NORMAL

12. PATENT DUCTUS ARTERIOSUS
• QRS CONFIGURATION: DEEP S V1, TALL R V5 AND V6
• ATRIAL ENLARGEMENT: LAE WITH MODERATE PDA
• VENTRICULAR HYPERTROPHY: UNCOMMON
• PARTICULARITIES: OFTEN EITHER CLINICALLY SILENT OR EISENMENGER

13. EBSTEIN’S ANOMALY
• RHYTHM: NORMAL SINUS RHYTHM, POSSIBLE EAR, SVT; AF/IART 40%
• PR INTERVAL: 1° AVB COMMON; SHORT IF WPW
• QRS AXIS: NORMAL OR LAD

14. EBSTEIN’S ANOMALY
• QRS CONFIGURATION: LOW-AMPLITUDE MULTIPHASIC ATYPICAL RBBB
• ATRIAL ENLARGEMENT: RAE WITH HIMALAYAN P WAVES
• VENTRICULAR HYPERTROPHY: DIMINUTIVE RV
• PARTICULARITIES: ACCESSORY PATHWAY COMMON; Q II, III, AVF, AND V1–V4

15. SURGICALLY REPAIRED TOF
• RHYTHM: NORMAL SINUS RHYTHM, PVCS; IART 10%; VT 12%
• PR INTERVAL: NORMAL OR MILD ↑
• QRS AXIS: NORMAL OR RAD; LAD 5% TO 10%

16. SURGICALLY REPAIRED TOF
• QRS CONFIGURATION: RBBB 90%
• ATRIAL ENLARGEMENT: PEAKED P WAVES; RAE POSSIBLE
• VENTRICULAR HYPERTROPHY: RVH POSSIBLE IF RVOT OBSTRUCTION
OR PHT
• PARTICULARITIES: QRS DURATION±QTD PREDICTIVE OF VT/SCD

17. COMPLETE TGA/INTRA-ATRIAL BAFFLE
• RHYTHM: SINUS BRADY 60%; EAR; JUNCTIONAL; IART 25%
• PR INTERVAL: NORMAL
• QRS AXIS: RAD

18. COMPLETE TGA/INTRA-ATRIAL BAFFLE
• QRS CONFIGURATION: ABSENCE OF Q, SMALL R, DEEP S IN LEFT
PRECORDIUM
• ATRIAL ENLARGEMENT: POSSIBLE RAE
• VENTRICULAR HYPERTROPHY: RVH; DIMINUTIVE LV
• PARTICULARITIES: POSSIBLE AVB IF VSD OR TV SURGERY

19. PULMONARY STENOSIS
• RHYTHM: NORMAL SINUS RHYTHM
• PR INTERVAL: NORMAL
• QRS AXIS: NORMAL IF MILD; RAD WITH
MODERATE/SEVERE

20. PULMONARY STENOSIS
• QRS CONFIGURATION: NORMAL; OR RSR´; R´ INCREASES WITH
SEVERITY
• ATRIAL ENLARGEMENT: POSSIBLE RAE
• VENTRICULAR HYPERTROPHY: RVH; SEVERITY CORRELATES WITH R:S IN
V1 AND V6
• PARTICULARITIES: AXIS DEVIATION CORRELATES WITH RVP

21. CONGENITALLY CORRECTED TGA
• RHYTHM: NORMAL SINUS RHYTHM
• PR INTERVAL: 1° AVB >50%; AVB 2%/YEAR
• QRS AXIS: LAD

22. CONGENITALLY CORRECTED TGA
• QRS CONFIGURATION: ABSENCE SEPTAL Q; Q IN III, AVF, AND RIGHT
PRECORDIUM
• ATRIAL ENLARGEMENT: NOT IF NO ASSOCIATED DEFECTS
• VENTRICULAR HYPERTROPHY: NOT IF NO ASSOCIATED DEFECTS
• PARTICULARITIES: ANTERIOR AVN; POSITIVE T PRECORDIAL; WPW WITH
EBSTEIN’S

23. COMPLETE TGA/INTRA-ATRIAL BAFFLE
• RHYTHM: SINUS BRADY 60%; EAR; JUNCTIONAL; IART 25%
• PR INTERVAL: NORMAL
• QRS AXIS: RAD

24. COMPLETE TGA/INTRA-ATRIAL BAFFLE
• QRS CONFIGURATION: ABSENCE OF Q, SMALL R, DEEP S IN LEFT
PRECORDIUM
• ATRIAL ENLARGEMENT: POSSIBLE RAE
• VENTRICULAR HYPERTROPHY: RVH; DIMINUTIVE LV
• PARTICULARITIES: POSSIBLE AVB IF VSD OR TV SURGERY

25. AORTIC COARCTATION
• RHYTHM: NORMAL SINUS RHYTHM
• PR INTERVAL: NORMAL
• QRS AXIS: NORMAL OR LAD
• QRS CONFIGURATION: NORMAL

26. AORTIC COARCTATION
• ATRIAL ENLARGEMENT: POSSIBLE LAE
• VENTRICULAR HYPERTROPHY: LVH, ESPECIALLY BY VOLTAGE CRITERIA
• PARTICULARITIES: PERSISTENT RVH RARE BEYOND INFANCY

27. THANK YOU