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Chronic Left Ventricular Volume Overload

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Insights into Electrocardiograms with MCQs

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Abstract

Several conditions can produce chronic left ventricular volume overload. These include chronic moderately severe aortic regurgitation, chronic mitral regurgitation or large left to right shunts across ventricular septal defect, patent ductus arteriosus, or atrioventricular septal defect. Electrocardiographic findings that can help in identifying different causes are discussed with diagrams and representative electrocardiograms. Summary and MCQs at the end of the chapter help in quick revision and self-assessment.

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References

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Author information

Authors and Affiliations

  1. Ex Senior professor and head of the department of cardiology, Jawaharlal Nehru Medical College, Ajmer, India

    Sitaram Mittal

Authors
  1. Sitaram Mittal
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Appendices

Summary

Aortic Regurgitation

  • In mild left ventricular volume overload, an electrocardiogram is apparently normal.

  • In moderate left ventricular volume overload, q wave in lead V5 and V6 becomes prominent and amplitude of R wave in lead V6 becomes more than the amplitude of R wave in lead V5. ST-segment is isoelectric or minimally elevated.

  • In gross left ventricular volume overload,

    • Depth of q wave in leads V5 and V6 increases.

    • Amplitude of R wave in leads V5 and V6 increases.

    • Depth of S wave in lead V1 increases.

    • ST-segment in lead V5 and V6 is minimally elevated.

    • T wave in leads V5 and V6 are positive and may be tall and peaked.

  • In the later stage, leads V5 and V6 show the following changes:

    • q wave depth decreases.

    • R wave amplitude remains unchanged.

    • ST-segment becomes downsloping and T wave becomes inverted.

Mitral Regurgitation

  • There are no diagnostic changes in mild and even moderate mitral regurgitation.

  • Only one-third of the patients with severe mitral regurgitation show electrocardiographic signs of left ventricular volume overload.

  • Electrocardiographic signs of left atrial enlargement are common. Magnitude of left atrial enlargement correlates with the magnitude of mitral regurgitation and indirectly with the magnitude of left ventricular volume overload.

  • In contrast to aortic regurgitation, S wave depth in lead V1 does not increase.

  • Mean frontal plane QRS axis remains normal.

Mitral Valve Prolapse

  • These patients may show shallow T wave inversion in leads II, III, aVF, V5, and V6. These changes do not correlate with left ventricular volume overload.

Myocarditis/Dilated Cardiomyopathy

  • In these conditions, voltage of the QRS complex is increased. ST-segment and T wave changes are, however, due to damage to myocardium and do not correlate with severity of volume overload.

Acute Mitral or Aortic Regurgitation

  • Produce sinus tachycardia. There is no chamber enlargement because of short duration of illness.

MCQs

Q1. Which condition produces significant left ventricular volume overload?

  1. (a)

    Atrioventricular septal defect with severe pulmonic stenosis

  2. (b)

    Aortopulmonary window with severe pulmonary hypertension

  3. (c)

    Patient ductus arteriosus with large left to right shunt

  4. (d)

    All

Q2. Which condition produces significant left ventricular volume overload?

  1. (a)

    Large ventricular septal defect with normal pulmonary vascular resistance

  2. (b)

    Secundum atrial septal defect with large left to right shunt

  3. (c)

    Ventricular septal defect with severe pulmonic stenosis

  4. (d)

    Coronary arteriovenous fistula

Q3. Significant pulmonary artery hypertension is common in

  1. (a)

    Chronic aortic regurgitation

  2. (b)

    Nonrheumatic mitral regurgitation

  3. (c)

    Muscular ventricular septal defect

  4. (d)

    Aortopulmonary window

Q4. Prominent R wave in lead V6 is common with

  1. (a)

    Rheumatic mitral regurgitation

  2. (b)

    Chordal rupture

  3. (c)

    Rupture of sinus of Valsalva in left ventricle

  4. (d)

    Rupture of the interventricular septum

Q5. Chronic left ventricular volume overload is characterized by

  1. (a)

    Absence of septal q wave in lead V6

  2. (b)

    Broad and deep q wave in lead V6

  3. (c)

    Prominent but narrow q wave in lead V6

  4. (d)

    Prominent q in leads V3 and V4

Q6. Chronic moderately severe aortic regurgitation is characterized by

  1. (a)

    Tall R wave in lead V6

  2. (b)

    Tall R wave in leads V3 and V4

  3. (c)

    Deep S wave in lead V1

  4. (d)

    Deep S wave in lead V6

Q7. Chronic mitral regurgitation does not produce

  1. (a)

    Tall R wave in lead V6

  2. (b)

    Deep S wave in lead V1

  3. (c)

    Small S wave in lead V1

  4. (d)

    Large equiphasic QRS in leads V3 and V4

Q8. Ventricular septal defect with large left to right shunt does not produce

  1. (a)

    Deep S wave in lead V1

  2. (b)

    Large equiphasic QRS in leads V3 and V4

  3. (c)

    “P- mitral”

  4. (d)

    Tall R wave in lead V6

Q9. Atrial fibrillation supports the possibility of

  1. (a)

    Chronic rheumatic mitral regurgitation

  2. (b)

    Chronic severe aortic regurgitation

  3. (c)

    Ventricular septal defect with large left to right shunt

  4. (d)

    Patent ductus arteriosus with large left to right shunt

Q10. Left-axis deviation can be seen in

  1. (a)

    Atrioventricular septal defect

  2. (b)

    Chronic severe aortic regurgitation

  3. (c)

    Perimembranous ventricular septal defect

  4. (d)

    Chronic rheumatic mitral regurgitation

Q11. Biatrial enlargement is not seen in

  1. (a)

    Chronic aortic regurgitation

  2. (b)

    Chronic rheumatic mitral regurgitation

  3. (c)

    Ventricular septal defect with pulmonary artery hypertension

  4. (d)

    Patent ductus arteriosus with large left to right shunt

Q12. In chronic left ventricular volume overload, which finding closely correlates with dilatation and hypertrophy of the left ventricle?

  1. (a)

    R wave amplitude in lead V6

  2. (b)

    S wave depth in lead V1

  3. (c)

    ST-segment and T wave inversion in leads V5 to V6

  4. (d)

    U wave inversion

Q13. Normally R wave amplitude is maximal in

  1. (a)

    Lead I

  2. (b)

    Lead aVL

  3. (c)

    Lead V5

  4. (d)

    Lead V6

Q14. In moderately severe chronic aortic regurgitation

  1. (a)

    q wave becomes prominent in lead V5

  2. (b)

    R wave amplitude increase in lead V6

  3. (c)

    T wave is inverted in leads V5 and V6

  4. (d)

    ST-segment is depressed in leads I and aVL

Q15. In long-standing severe aortic regurgitation

  1. (a)

    q wave depth decreases in lead V5

  2. (b)

    ST segment is depressed in lead V5

  3. (c)

    T wave is tall and peaked in V5

  4. (d)

    Mean frontal plane QRS axis of −90°

Q16. In moderately severe chronic mitral regurgitation, there is

  1. (a)

    Left-axis deviation

  2. (b)

    Deep S wave in lead V1

  3. (c)

    Left atrial enlargement

  4. (d)

    T wave inversion is inverted in lead V6

Q17. In mild mitral regurgitation due to mitral valve prolapse, there may be

  1. (a)

    Shallow T wave inversion in leads II, III, aVF

  2. (b)

    Shallow T wave inversion in leads V5, V6

  3. (c)

    Deep symmetrical T wave inversion in leads V5, V6

  4. (d)

    Deep q wave in leads V5, V6

Q18. In case of myocarditis, magnitude of volume overload correlates with

  1. (a)

    Amplitude of R wave in lead V5

  2. (b)

    Width of Q wave in lead V5

  3. (c)

    Inversion of T wave in lead V5

  4. (d)

    None

Q19. In acute severe mitral regurgitation, there is

  1. (a)

    Gross left atrial enlargement

  2. (b)

    Deep prominent q wave in lead V6

  3. (c)

    Tall R wave in lead V6

  4. (d)

    None

Q20. Acute aortic regurgitation produces

  1. (a)

    Sinus tachycardia

  2. (b)

    Deep q in leads V5 and V6

  3. (c)

    Tall R in leads V5 and V6

  4. (d)

    All

Answers

(1) c (2) a (3) d (4) a (5) c (6) a, c (7) b, d (8) a (9) a (10) a, b (11) a, d (12) c, d (13) c (14) a, b (15) a, b (16) c (17) a, b (18) d (19) d (20) a

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Mittal, S. (2023). Chronic Left Ventricular Volume Overload. In: Insights into Electrocardiograms with MCQs. Springer, Singapore. https://doi.org/10.1007/978-981-99-0127-2_31

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  • DOI: https://doi.org/10.1007/978-981-99-0127-2_31

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-99-0126-5

  • Online ISBN: 978-981-99-0127-2

  • eBook Packages: MedicineMedicine (R0)

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