Background history of hypertension and smoking.
Check out the comments from our original post here.
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- 90 bpm
- Sinus Arrhythmia
- PR - Normal (~200ms)
- QRS - Normal (100ms)
- QT - 400ms (QTc Bazette 380-400 ms)
- ST Elevation leads V1 (2mm), V2 (2-2.5mm), aVR (1mm)
- ST Depression II, III, aVF, V5-6
- Voltage criteria LVH
- S wave V1 + R wave V5 = 24mm + 14mm = 38mm
- Left Arial Enlargement
- ST changes proportional to S wave voltage
- ST to S wave ratio <25%
In this case the changes due to LVH were thought to represent acute MI and the patient was taken for urgent angio which was essentially normal.
There are a few nice reviews on LVH and ACS look at decision rules to help distinguish LVH from LVH + acute AMI that I'd recommend:
Also a number of cases from Dr Smith involving LVH:
References / Further Reading
Life in the Fast LaneTextbook
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.