Myocardial hypertrophy refers to the increase in the thickness of the heart's muscular wall, and myocardial enlargement refers to hypertrophy associated with the dilation of the cardiac chambers, typically the atria. Both myocardial hypertrophy and enlargement present specific findings on ECG and can help to identify which chamber of the heart that's involved. For example, the right atrial enlargement shows a big P wave in lead II and V1, whereas the right ventricular hypertrophy shows a big R wave in V1 and a big S wave in V5 and V6.
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