The Cardiographic Diagnosis of Combined Ventricular Hypertrophy

Abstract

The introduction of unipolar lead cardiography has renewed interest in the cardiographic diagnosis of biventricular hypertrophy or strain. East and Bain (1948) stated that this diagnosis could often be made with the help of unipolar leads, but recent studies by Garouso et al. (1949), Soulie et al. (1949), Rosenman et al. (1950),and .Levine and Phillips (1951) do not entirely support this view. The following investigation was undertaken to determine the frequency of cardiographic findings in this condition and, if possible, to establish reliable criteria for the diagnosis. CASE MATERIAL AND METHODS Three groups were studied: Group I-26 patients with isolated right ventricular hypertrophy; Group II-30 patients with isolated left ventricular hypertrophy; and Group 111-51 patients with right and left ventricular hypertrophy. Autopsy confirmation was obtained in all cases and unipolar as well as standard bipolar leads were recorded in all, using a Vector photographic machine and a Sanborn " Visocardiette " direct-writing instrument. Unipolar limb and chest leads were recorded by the technique of Goldberger (1947) (1 cm.=15 mv. for limb leads. 1 cm.=1 mv. for chest leads). The standard limb leads have been omitted from the analysis since they did not contribute any information not obtainable from a study of the unipolar leads. All age groups were represented. Cases of ischoemic heart disease, cardiac infarction, or cardiac aneurysm were excluded. Right bundle branch block was present in 3 cases in Group III, and left bundle branch block in 4 cases in Group II and 4 cases in Group III; these cases were excluded from the analysis of cardiographic signs, but were retained in the series as a whole. kTIOLOGY AND PATHOLOGICAL CRITERIA OF VENTRICULAR HYPERTROPHY All the common causes of heart disease were found, the most frequent being: in Group I pulmonary heart disease; in Group II, hypertension; and in Group III, combined aortic and mitral valve lesions, and pulmonary heart disease associated with systemic hypertension. Three degrees of hypertrophy were recognized. For the right ventricle, a thickness of the wall of 5 to 7 mm. was denoted by +, 8 to 10 mm. by ++, and more than 10 mm. by +++; for the left ventricle, 15 to 18 mm. was denoted by +, 19 to 24 mm. by + +, and more than 24 mm. by + + +. In the few cases in which the wall was not measured in millimetres, an assessment was made in keeping with the above criteria, and based on the weight of the heart. Measurements were made at the outflow tract region of the right ventricle, the maximum muscle thickness being recorded, in both ventricles. CARDIOGRAPHIC CRITERIA OF VENTRICULAR HYPERTROPHY The features of isolated hypertrophy of the left or right ventricle respectively which were studied have been based on criteria used in this department and on work by Goldberger (1947), Sokolow and Lyon (1949), and Myers (1948 and 1950). The findings indicative of hypertrophy of both ventricles in Group III were derived from these criteria.

Zur vektorkardiographischen Darstellung der Kammerhypertrophie

“…Derselbe Autor unterscheidet auch zwei Typen von QRS-Schlingen. und zwar mehr langgestreckte, die der Ionogenen Hypertrophie, und mehr verbreiterte, die der myogenen Dilatation, zugeordnel wer den (30). Auch Bilyer unterscheidet im Laufe der Entwicklung einen Typ I mit schmalen und länglichen, sowie einen Typ II mit breiten QRS-Vektorschlingen (2,5).…”

Postoperative Changes in the Electrocardiogram in Congenital Heart Disease

“…The upper limit of the time of onset of the intrinsicoid deflection V, in normal children is estimated at approximately 0.030 second.7' 35,40,44 An increase in this measurement is considered by many investigators a strongly suggestive sign of right ventricular hypertrophy. '0' 11,19,37,41 In the present study, the average time of onset of the intrinsicoid deflection in V1 was 0.048 second.…”

Electrocardiography in Mitral Valvular Disease

“…Altogether such negative T waves were found in 18 cases and negative T waves in VI and V2 in another 10. Pagnoni and Goodwin (1952) accept R >S in VI and a ventricular activation time in VI > 0 03 sec. as direct signs of R.V.H., and consider S >R in V5 and a predominantly positive deflection in aVR as indirect signs indicative of extreme clockwise rotation or backward apical rotation, and virtually diagnostic of R.V.H.…”