ECG of Atrial Enlargement

by Joseph Alpert, MD

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    00:01 So let's just talk about right and left atrial enlargement by themselves just to review.

    00:05 We've talked about this before. Here's the normal P wave, right? It's 3 boxes in duration or less, not wider than that. It's upright in leads 1 and 2 and doesn't have a big negative deflection for example in V1. In V1, you'll see in a moment the big negative deflection that suggest left atrial enlargement.

    00:28 So here we see a very nice example. Spiky, tall, and broad P wave in lead 2.

    00:35 Right atrial enlargement. In this case, it's 2.5 mm in height and in V1, it's upright.

    00:46 It's not inverted as here in left atrial enlargement, look at the secondary component of the P wave.

    00:53 You notice how inverted and deep it is? That's left atrial enlargement.

    00:59 And you could see at the length of the P wave is also prolonged more than three little boxes so it's more than a 120 ms and there's the downward deflection of greater than 40 ms and 1 mm wide big deep inverted secondary component of V1 suggest left atrial enlargement.

    01:19 Here we see another form of left atrial enlargement.

    01:22 This is often seen with mitral stenosis.

    01:25 You'll notice the big broad P wave and the double hump on it spelling the letter M.

    01:31 So, it says mitral valve disease--mitral stenosis--and over in V1, again, you see a prolonged deep inverted secondary component.

    01:42 Both of these suggesting left atrial enlargement.

    01:46 Tall P waves higher than 2 little boxes, notice in aVL in green, this suggests right atrial enlargement.

    About the Lecture

    The lecture ECG of Atrial Enlargement by Joseph Alpert, MD is from the course Electrocardiogram (ECG) Interpretation. It contains the following chapters:

    • P-Wave Morphology and Voltage
    • Left Atrial Enlargement (LAE)
    • Right Atrial Enlargement (RAE)

    Included Quiz Questions

    1. Tall P waves higher than 2.5 little boxes (2.5 mm, 0.1 mV) in lead II
    2. P wave that is upright in leads 1 and 2 with a negative deflection less than 1 little box (0.04 s) wide and 1 little box (1 mm, 0.1 mV) deep in V1
    3. Presence of an inverted and deep second component of the P wave
    4. Tall R waves in V1 with a deep S wave in the lateral leads
    5. Wide P waves with an inverted final component in lead V1

    Author of lecture ECG of Atrial Enlargement

     Joseph Alpert, MD

    Joseph Alpert, MD

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    Great lecture
    By Jona T. on 11. April 2020 for ECG of Atrial Enlargement

    This lecture help me a lot !! Very important information in this course