The Martians have a death beam pointed at Earth. With the fate of the universe on the line, you have one chance to answer the following question correctly to save the planet: Does this ECG show left atrial, right atrial, or biatrial enlargement?
ECG 1
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- Biatrial enlargement
- Lead II - p-pulmonale (~2.5 mm) suggests RAE
- Lead V1 - Biphasic P wave
- Positive component ≤ p in V6 and < 1.5mm so not suggestive of RAE
- Negative component
- Depth ≥ 1mm or width ≥ 0.04 s suggests LAE.
- Width (0.04s) x depth (2mm) ≥ 0.03 mms suggests LAE
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ECG 2
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- Biatrial enlargement
- Lead II - p-pulmonale (≥2.5mm) and p-mitrale (double notched) suggest RAE and LAE
- Lead V1 - Biphasic P wave
- Positive component ≤ p in V6 and < 1.5mm so not suggestive of RAE
- Negative component
- Depth ≥ 1mm and width ≥ 0.04 s suggests LAE.
- Width (0.08s) x depth (3mm) ≥ 0.03 mms suggests LAE
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ECG 3
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- Left atrial enlargement
- Lead II - wide p wave but no p-mitrale pattern or p-pulmonale
- Lead V1 - Biphasic
- Positive component ≤ p in V6 and < 1.5mm so not RAE
- Negative component
- Depth ≥ 1mm and width ≥ 0.04 s suggests LAE.
- Width (0.07s) x depth (2.3mm) ≥ 0.03 mms suggests LAE
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ECG 4
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- Right atrial enlargement
- Lead II - p-pulmonale (≥2.5mm) suggests RAE
- Lead V1 - Biphasic
- Positive component > p in V6 and ≥ 1.5mm suggests RAE
- Negative component
- Depth ≤ 1mm and width ≤ 0.04 s - not suggestive of LAE
- Width (0.03s) x depth (0.5mm) < 0.03 mms - not suggestive LAE
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ECG 5
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- Biatrial enlargement
- Lead II: P-pulmonale (≥ 2.5mm) , indicating RAE.
- Lead V1: Biphasic
- Positive component ≤ V6 and < 1.5 mm does not suggest RAE
- Negative component
- Depth ≥ 1mm and width ≥ 0.04 s suggests LAE.
- Width (0.04s) x depth (1mm) ≥ 0.03 mms suggests LAE
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ECG 6
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- RAE or Biatrial Enlargement
- Lead II - no signs of LAE or RAE
- Lead V1 - biphasic P wave
- Positive component > p in V6 and ≥1.5 mm suggests RAE
- Negative component
- In some beats - Depth ≥ 1mm or width ≥ 0.04 s suggests LAE but difficult to distinguish if part of p wave or PR segment
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ECG 7
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- Biatrial Enlargement
- Lead II - P-pulmonale (≥2.5 mm) suggests RAE
- Lead V1 - Biphasic P wave
- Positive component ≤ p in V6 and < 1.5mm does not suggest RAE
- Negative component
- Depth ≥ 1mm or width ≥ 0.04 s suggests LAE.
- Width (0.06s) x depth (1 mm) ≥ 0.03 mms suggests LAE
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ECG 8
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- LAE
- Lead II - no p mitrale or pulmonale
- Lead V1 - Biphasic P
- Positive component ≤ p in V6 and < 1.5 mm does not suggest RAE
- Negative component
- Depth ≥ 1mm or width ≥ 0.04 s suggests LAE
- Depth (1mm) x Width (0.12 s) ≥ 0.03 mms suggests LAE
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ECG 9
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- Right atrial enlargement
- Lead II - P-pulmonale and RAE
- Lead V1 - not biphasic, cannot determine LAE
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ECG 10
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- Left atrial enlargement
- Lead II - no p-pulmonale or mitrale
- Lead V1 - biphasic
- Positive portion ≤ p in V6 and < 1.5mm so not suggestive of RAE
- Negative portion
- Depth ≥ 1mm or width ≥ 0.04 s suggests LAE
- Depth (1.5mm) x Width (0.08 s) ≥ 0.03 mms suggests LAE
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ECG 11
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- Left atrial enlargement
- Lead II - p mitrale (double notches) suggests LAE
- Lead V1 - biphasic
- Positive component ≤ p in V6 and 1.5 mm so not suggestive of RAE
- Negative component
- Depth ≥ 1mm or width ≥ 0.04 s suggests LAE
- Depth (1 mm) x Width (0.08 s) ≥ 0.03 mms suggests LAE
- Source: Nathanson LA, McClennen S, Safran C, Goldberger AL. ECG Wave-Maven: Self-Assessment Program for Students and Clinicians. http://ecg.bidmc.harvard.edu.
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ECG 12
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- Left atrial enlargement or biatrial enlargement
- Lead II - no p-pulmonale or mitrale
- Lead V1 - biphasic
- Positive component > p in V6 and ~ 1.5 mm suggests RAE
- Negative component
- Depth ≥ 1mm or width ≥ 0.04 s suggests LAE
- Depth (1mm) x Width (0.04s) ≥ 0.03 mms suggests LAE
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ECG 13
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- Left atrial enlargement
- Lead II - P-mitrale suggests LAE
- Lead V1 - biphasic
- Positive component ≤ p in V6 so not suggestive of RAE
- Negative component
- Depth ≥ 1mm or width ≥ 0.04 s suggests LAE
- Depth (1mm) x Width (0.10 s) ≥ 0.03 mms suggests LAE
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ECG 14
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- Biatrial enlargement
- Lead II - p-pulmonale suggests RAE
- Lead V1 - biphasic
- Positive component ≤ p in V6 and < 1.5mm so not suggestive of RAE
- Negative component
- Depth ≥ 1mm or width ≥ 0.04 s suggests LAE
- Depth (1 mm) x Width (0.08 s) ≥ 0.03 mms suggests LAE
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ECG 15
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- Right atrial enlargement
- Lead II - P pulmonale (≥2.5 mm) suggests RAE
- Lead V1 - no biphasic P
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ECG 16
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- Left atrial enlargement
- Lead II - no p-pulmonale or mitrale
- Lead V1 - biphasic
- Positive component ≤ p in V6 and < 1.5 mm so not suggestive of RAE
- Negative component
- Depth ≥ 1mm or width ≥ 0.04 s suggests LAE
- Depth (1mm) x Width (0.05 s) ≥ 0.03 mms suggests LAE
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ECG 17
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- Biatrial enlargement
- Lead II - p-pulmonale (≥2.5mm) suggests RAE
- Lead V1 - biphasic
- Positive portion ≤ V6 so not suggestive of RAE
- Negative portion
- Depth ≥ 1mm or width ≥ 0.04 s suggests LAE
- Depth (1mm) x Width (0.08 s) ≥ 0.03 mms suggests LAE
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ECG 18
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- Left atrial enlargement
- Lead II - p mitrale is present which suggests LAE
- Lead V1 - biphasic
- Positive component ≤ V6 and < 1.5mm so not suggestive of RAE
- Negative component
- Depth ≥ 1mm or width ≥ 0.04 s suggests LAE
- Depth (1mm) x Width (0.04 s) ≥ 0.03 mms suggests LAE
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ECG 19
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- Left atrial enlargement
- Lead II - no p-pulmonale or mitrale
- Lead V1 - biphasic
- Positive component ≤ V6 and < 1.5mm so not suggestive of RAE
- Negative component
- Depth ≥ 1mm or width ≥ 0.04 s suggests LAE
- Depth (2.5mm) x Width (0.10 s) ≥ 0.03 mms suggests LAE
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ECG 20
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- Biatrial enlargement
- Lead II - p-mitrale suggests LAE
- Lead V1 - biphasic
- Positive component > V6 and ≥ 1.5 mm which suggests RAE
- Negative component
- Depth ≥ 1mm or width ≥ 0.04 s suggests LAE
- Depth (1 mm) x Width (0.08 s) ≥ 0.03 mms suggests LAE
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ECG 21
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- Right atrial enlargement
- Lead II - p pulmonale present which suggests RAE
- Lead V1 - not biphasic - entirely inverted, cannot assess for RAE or LAE
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ECG 22
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- Biatrial enlargement
- Lead II - p pulmonale (≥2.5mm) suggests RAE
- Lead V1 - Biphasic (there is a positive component if you zoom in)
- Positive component ≤ V6 and < 1.5mm so not suggestive of RAE
- Negative component
- The negative component is well over 1mm deep (1 small box) and 0.04 s (1 small box) wide.
- The depth (2.5mm) x width (0.08s) ≥ 0.03 mms which is consistent with LAE
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This post is for education and not medical advice.