ECG of the Week – 5th March 2018 – Interpretation

By | 7 maart 2018

The following ECG is from a 35 yr old male who presented to the Emergency Department following a brief episode of atypical chest pain.

 

Click to enlarge



Rate:

  • 66

Rhythm:

  • Regular
  • Sinus rhythm

Axis:

  • Normal

Intervals:

  • PR – Normal (~200ms)
  • QRS – Normal (80-100ms)

Additional:

  • Voltage criteria LVH
    • Lead V5 & V6 R > 26mm
    • S V1 + R V5 or V6 > 35mm
    • R wave in aVF > 20 mm
    • S wave in aVR > 14 mm
  • Non-voltage LVH criteria
    • LV ‘Strain’ Pattern
    • ST Depression leads I, II, III, aVF, V4-6
    • T wave inversion leads I, II, III, aVF, V4-6
  • Deep Q waves leads V4-6
 
Interpretation:
  • Voltage criteria for LVH with secondary ST segment and T wave changes

 Whilst voltage criteria for LVH can be a normal variant especially in young fit patients this should not be associated with Q waves or secondary ST / T changes.The presence of LVH with Q waves and / or ST / T wave changes in a young patient is concerning for potential hypertrophic cardiomyopathy (HCM) and requires further investigation and referral to cardiology team. This patient had known HCM and is awaiting a septal myectomy. 

References / Further Reading
 
Life in the Fast Lane

Textbook

  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.

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ECG of the Week – 5th March 2018 – Interpretation

By | 7 maart 2018

The following ECG is from a 35 yr old male who presented to the Emergency Department following a brief episode of atypical chest pain.

 

Click to enlarge



Rate:

  • 66

Rhythm:

  • Regular
  • Sinus rhythm

Axis:

  • Normal

Intervals:

  • PR – Normal (~200ms)
  • QRS – Normal (80-100ms)

Additional:

  • Voltage criteria LVH
    • Lead V5 & V6 R > 26mm
    • S V1 + R V5 or V6 > 35mm
    • R wave in aVF > 20 mm
    • S wave in aVR > 14 mm
  • Non-voltage LVH criteria
    • LV ‘Strain’ Pattern
    • ST Depression leads I, II, III, aVF, V4-6
    • T wave inversion leads I, II, III, aVF, V4-6
  • Deep Q waves leads V4-6
 
Interpretation:
  • Voltage criteria for LVH with secondary ST segment and T wave changes

 Whilst voltage criteria for LVH can be a normal variant especially in young fit patients this should not be associated with Q waves or secondary ST / T changes.The presence of LVH with Q waves and / or ST / T wave changes in a young patient is concerning for potential hypertrophic cardiomyopathy (HCM) and requires further investigation and referral to cardiology team. This patient had known HCM and is awaiting a septal myectomy. 

References / Further Reading
 
Life in the Fast Lane

Textbook

  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.

Geef een reactie

Deze website gebruikt Akismet om spam te verminderen. Bekijk hoe jouw reactie gegevens worden verwerkt.