ECG and CXR in ventricular septal defect

ECG and CXR in ventricular septal defect ECG in ventricular septal defect ECG is normal in a small ventricular septal defect. Large VSD with large left to right shunt will have left ventricular volume overload with small q, tall R and upright T waves in lateral leads. Large VSD progresses to biventricular overload when there is hyperdynamic pulmonary hypertension. The ECG pattern of biventricular hypertrophy is called Katz – Wachtel phenomenon with tall biphasic (R=S) QRS complexes with amplitude over 50 mm in mid precordial leads. This pattern is usually seen in children. Since the QRS amplitude is high it often overshoots the margin of the ECG graph as seen in lead V4 in this case. It may be necessary to take ECG in half standardization (5 mm to a millivolt instead of 10 mm to a millivolt) to capture the full QRS complex without overlapping with other leads in simultaneous multichannel recordings. Standard single channel ECG paper has a height of 50 mm for the graph. Large anterior electrocardiographic forces are due to the hypertrophied right ventricle and late posterior forces due to the hypertrophied left ventricle. Katz-Wachtel phenomenon in VSD with large left to right shunt Tall biphasic QRS complexes in mid precordial leads suggestive of Katz-Wachtel phenomenon in VSD with large left to right shunt. AV canal VSD (inlet VSD, endocardial cushion defect) is associated with left axis deviation in the ECG. Complete heart block, both transient and permanent can occur aft...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: HBC Katz – Wachtel phenomenon peripheral pruning Source Type: blogs