El electrocardiograma en las hipertrofias ventriculares / ECG in ventricular hypertrophy

RESUMO

The electrophysiological criteria for the diagnosis of ventricular hypertrophies, in the light of the sequence of ventricular depolarization and repolarization, are described. Hypertrophy of the right ventricle due to sustained systolic overloading can be global or segmental. In the first case, the magnitude and manifestation of the main vectors resulting from depolarization of this ventricle, i.e., IIs, IIr and IIIr, are increased. In the second case, the magnitude and manifestation of only some vectors resulting from its depolarization are increased; for example, vector IIr (right parietal) in the most frequent type of Fallot's tetralogy and vector IIIr (right basal) in chronic corpulmonale of obstructive origin. Left ventricular hypertrophy, which is generally of global type (aortic stenosis, systemic arterial hypertension), induces an increase in magnitude and manifestation of all the main vectors resulting from depolarization of this ventricle: I (first septal), II (left parietal) and III (left basal). But the left ventricular hypertrophy can also be of segmental type; for example, in idiopathic hypertrophic cardiomyopathy, in which the manifestation of an anteroseptal vector usually predominates. Biventricular hypertrophies produce different electrocardiographic patterns, depending on the preponderance of right or left electromotive ventricular forces. An example of electrocardiographic findings in biventricular hypertrophy is presented. It corresponds to an 18 year-old woman with a large patent ductus arteriosus compressing the left inferior laryngeal nerve, which produced a cardio-vocal syndrome. The patient had pulmonary and systemic hypertension and arterial hyposaturation. The surgical treatment of the patent ductus arteriosus normalized the pulmonary pressure as well as the arterial saturation.