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DISSERTATION

ABSTRACT
“ CORRELATION OF ECG,CHEST X-RAY AND 2D ECHO IN PATIENTS WITH VENTRICULAR HYPERTROPHY “

DR.B.SATYAKIRAN
1st YEAR RESIDENT,MD.GENERAL MEDICINE.
MNR MEDICAL COLLEGE AND HOSPITAL,FASALWADI,SANGAREDDY.
UNIVERSITY-KALOJI NARAYAN RAO UNIVERSITY OF HEALTH SCIENCES. WARANGAL.
GUIDE: DR.B.SIVA SUBRAHMANYAM. M.D.Gen.Med.
Professor,Dept. Of General Medicine
INTRODUCTION
• Ventricular hypertrophy is an independent risk factor for cardiovascular morbidity and 10 year
mortality as a risk factor for myocardial infarction, heart failure, arrhythmias, sudden cardiac death.

• Presence of left ventricular hypertrophy is used as indication for treatment of young patients having
borderline or labile hypertension.

• Right ventricular hypertrophy occurs due to chronic lung diseases or structural diseases of heart.

• Most common cause of Right ventricular hypertrophy is pulmonary hypertension which may be caused
due to copd, sleep apnea, restrictive lung diseases, embolism.

• Structural diseases of heart like tricuspid insufficiency ,pulmonary valve stenosis, tetralogy of fallot,
septal defects.
AIM OF STUDY

• Correlation between ecg , chest xray and 2d echo in diagnosing ventricular hypertrophy

OBJECTIVE OF STUDY
• To study the prevalence of ventricular hypertrophy in patients with clinical features of heart disease.

• To assess and compare the findings of ventricular hypertrophy using ecg, chest xray and echo in
evaluating hypertrophy or volume overload.
MATERIALS AND METHODS
Materials
• Source of data (study setting) : patients attending the outpatient department of MNR MEDICAL
COLLEGE AND HOSPITAL , Sangareddy.

• Study Period :from November 2022 and May 2024.

• Equipment : ecg machine , echocardiography machine, xray machine available in the institution.

• Study population : patient with clinical features of heart disease, showing findings of ventricular
hypertrophy on ecg, chest xray.

• Study design : Observational study


METHODOLOGY
• Selection of patients with chief complaints like
- Chest pain
- Dyspnea
- Palpitations
- Pedal edema
• Recording the vital parameters (BP, pulse, RR) and history of known comorbidities like diabetes ,
hypertension
• Ecg –
LVH (Left ventricular hypertrophy)
• sokolov lyon criteria
• S wave in V1 + R wave in V5-6 > 35 mm
• Cornell voltage criteria
• R wave in aVL >11mm
Other
• R in V5 or V6 > 26mm
• R in aVF or lead II or lead III > 20mm.
• R in lead I > 15mm
• S in v1 or v2 >25mm
Left axis deviation – QRS between -30 and – 90 degrees
RVH (right ventricular hypertrophy)
• Right axis deviation of atleast 110 degrees.
• Sokolow lyon criteria
• R wave in V1 + S wave in lead V5 or V6 > 1.1 mv
• R in V1 > 7mm
• S in V5 or V6 > 7mm
• R/S in V1 > 1
• R/S in V5 or V6 < 1
• Right bundle branch block.

ECHOCARDIOGRAPHY CRITERIA

LVH – left ventricular hypertrophy


3 3
• LV mass = 1.05 [ ( IVS + LVPW + LVEDD) – LVEDD ] – 14.
• Thickness of IVS and LVPW diameter in diastole > 12mm.
• IVS : diastolic thickness of IV septum.
• LVPW : diastolic thickness of posterior wall
• LVEDD : end diastolic dimension of the ventricle.
In case of LV hypertrophy LV mass exceeds 136 gms in men and 112 grams in women.

RVH-– Right ventricular hypertrophy


Normal wall thickness of right ventricle is 2-5mm.
Thickness more than 5mm suggests hypertrophy
INCLUSION CRITERIA
X ray criteria
cardiomegaly
Cardiothoracic ratio > 0.5

Ecg criteria
Left/Right ventricular hypertrophy
Left/ right axis deviation

EXCLUSION CRITERIA
• Patient with very thin chest wall ( chest circumference <38 inches)
• Chest pain due to other causes like acid peptic disease/ musculoskeletal .
• obese individuals (BMI >30) with poor echogenic window.
REVIEW OF LITERATURE
1)Prevalence and determinants of left ventricular hypertrophy among elderly hypertensive patients attending tertiary health care
center in West Bengal, India
Poonam Kushwaha, Bijay Prakash Yadav
Annals of Geriatric Education and Medical Sciences. 2022; 9(1): 16
[Pubmed] | [DOI]
2)Comparison of Various ECG Criteria in the Diagnosis of Left Ventricular Hypertrophy Using Echocardiography as Gold Standard
Gailin B. Sebastian,Ish Kalra,Zameel A,Farha Ahmed Payyanil Karlath,Vivek S. Narayan Pillai
Journal of Evidence Based Medicine and Healthcare. 2020; 7(8): 377
[Pubmed] | [DOI]
3)Role of echocardiography in clinical hypertension
Jae-Hwan Lee & Jae-Hyeong Park
Clinical Hypertension volume 21, Article number: 9 (2015)
4)Efficacy of echocardiography for differential diagnosis of left ventricular hypertrophy: special focus on speckle-tracking
longitudinal strain
Hidekazu Tanaka Journal of Echocardiography volume 19, pages71–79 (2021)
5)ELECTROCARDIOGRAPHIC AND ECHOCARDIOGRAPHIC EVALUATION OF LEFT VENTRICULAR . HYPERTROPHY IN HYPERTENSIVE
PATIENTS- A HOSPITAL-BASED STUDY
Ashok Singh,Bhaskar Baruah,Chitralekha Baruah .Journal of Evolution of Medical and Dental Sciences. 2018; 7(10): 1189 [Pubmed] |
[DOI]
6)Electrocardiogram and echocardiographic study of left ventricular hypertrophy in patients with essential hypertension in a
teaching medical college
K Venugopal, Srikant R Gadwalkar, P Ramamurthy
Department of General Medicine, Vijayanagara Institute of Medical Sciences, Bellary, Karnataka, India .18-May-2016
7)Consistency of left ventricular hypertrophy diagnosed by electrocardiography and echocardiography: the Northern Shanghai
Study
Authors Zhang W, Zhou Y, Bai B, Yu S, Xiong J, Chi C, Teliewubai J, Li J, Blacher J, Zhang Y, Xu Y
Published 11 March 2019 Volume 2019:14 Pages 549—556
REFERENCES
1)Braunwald’s heart disease, a textbook of cardiovascular medicine.

2)The practice of clinical echocardiography by Catherine . M . Otto

3)Echo made easy – by dr atul Luthra

4)Harrison s textbook of internal medicine.


PROFORMA
• Variables recorded
• Name:
• Age:
• OP No.:
• Sex:
• Occupation:
• Height:
• Weight:
• Chest circumference:
• Blood pressure:
• Pulse rate:
Investigations:
1)ECG
2)Chest Xray –PA view
3)2D Echo
(Patient Information Leaflet)
• Study Title: “Correlation of ECG , Chest X-ray, 2D echo in patients with ventricular hypertrophy”
Principal investigator’s name: Dr.B.Satyakiran.
Principal investigator’s title: P.G.(1st yr, Department of General Medicine)
Place: MNR Medical College and Hospital, Sangareddy
• You can go through the information leaflet and take decision whether to be part of the study or not.
Your decision will not have any effect on your medical care now or in the future. You can opt out of the
study anytime. If you do opt out, it will not affect the quality of treatment you get now or in the future.
• About the Study
• This study is based on observational study of investigating the patient with ventricular hypertrophy on
ecg, chest xray and 2d echo
• Who should take part in the study?
• Patient with complaints of heart disease like chest pain, dyspnea, palpitations, known hypertensive.
• Do I need to take any medicines or undergo any investigations?
• There is no need to take any medications for this study. This study needs to record the ecg, chest xray
and 2d echo.
• Are there any disadvantages/Risks of taking part in the study?
• The study has absolutely no disadvantages and no risks.
• What are the advantages of taking part in the study?
• The study is about your health status. It may help in early detection of abnormality if any. Moreover,
you will be contributing to the betterment of the health system in the society.
• If I don’t take part, will it affect my treatment?
• Absolutely not. You will be getting the treatment as per the hospital policies.
• How long is the study?
• It is limited to the time of your hospital stay.
• What if I want to opt out of the study?
• You can opt out of the study anytime. If you opt out of the study, it will not affect either the course or
quality of treatment
• you get now or in the future.
• Where can I get further information?
• If you have any further questions about the study or if you need any further information now or at any
time in the future, please contact:
INFORMED CONSENT FORM
• TITLE:- “Correlation of ECG, Chest X-ray and 2D echo in patients with ventricular hypertrophy.”
• Principle Investigator:- Dr.B.Satyakiran
• Guide:- Dr.B.Siva subrahmanyam.
• Name : Age/Sex :
• Address: Informant/Guardian Name:-
• I have been given full information about the study and I understood its nature, purpose and duration.
All of my questions regarding the study are answered to my satisfaction.
• I understood that I am free to withdraw from the study at any given time. I have been given a copy of
this consent form to keep. By signing this I authorize the Doctor to publish my photos, videos, X-rays in
any textbooks or any publications. All the above said are explained to me in my understandable
language.
• Time :- Guardian/Informant Name:- Signature of Investigator:-
• Date :-
• Signature of Guardian/Informant :
• సమాచారం కన్స ంంట ం ఫారం
• ప్రధాన రరిశోధకుడు :
• గైడ్ :
• కో గైడ్ :
• పేరు :
• తేదీ :
• వయసు :
లింగ

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ిం

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డ యి.

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