ECG of the Week - 4th September 2017 - Interpretation

This ECG is from a 43 yr old male with chronic severe hypertension.

Click to enlarge

Rate:

• 132 bpm

Rhythm:

• Regular
• Sinus rhythm

Axis:

• Normal (-33 deg)

Intervals:

• PR - Normal (~180ms)
• QRS - Normal (100ms)

Additional:

• Voltage criteria LVH
• S V1 + R V5 = 35mm
• Non-voltage criteria LVH
• ST Depression V5-6 with T inversion
• Features suggesting additional RVH
• Deep S wave V5
• Biphasic high-voltage complexes V4-5
• Features of left atrial abnormality
• Wide and deep P waves in lead V1
• Notching of p wave in lead II
• Features of right atrial abnormality
• Tall P wave in lead II

Interpretation:

• Sinus tachycardia
• Features suggestive of four chamber enlargement

Note the ECG is poorly sensitive in detecting chamber enlargement and the terminology relating to p wave morphology now refers to atrial abnormality rather than atrial enlargement. 

Causes of Hypertension

• Primary / Essential Hypertension
• Secondary
• Renal causes
• Polycystic kidney disease
• Chronic kidney disease
• Urinary tract obstruction
• Renin-producing tumor
• Liddle syndrome
• Reno-vascular disease
• Vascular
• Coarctation of aorta
• Vasculitis
• Collagen vascular disease
• Endocrine
• Primary hyperaldosteronism
• Cushing syndrome
• Pheochromocytoma
• Congenital adrenal hyperplasia
• Hyperthyroidism and hypothyroidism
• Hypercalcemia
• Hyperparathyroidism
• Acromegaly
• Neurogenic
• Brain tumor
• Autonomic dysfunction
• Sleep apnea
• Intracranial hypertension
• Drugs and toxins
• NSAIDs
• Adrenergic medications
• Herbal remedies 
• Sympathomimetics
• OCP
• Steroids
• Other
• Obstructive sleep apnea
• Pregnancy-induced hypertension

References / Further Reading

Life in the Fast Lane

• LVH
• RVH
• Biventricular hypertrophy
• P wave

Textbook

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