ECG of the Week - 5th March 2018 - Interpretation

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

 

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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

• Left Ventricular Hypertrophy
• Hypertrophic Cardiomyopathy

Textbook

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