Wednesday, December 15, 2010

ECG Interpretation Review - #1 (LVH, Strain, Ischemia, LAE, RAE, RVH, LAA, RAA)

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QUESTION: Interpret the 12-lead ECG below.
  • Clinically - What do you suspect this patient has?
(ECG reproduced from ECG PB book - pg 40A)
- Note - Enlarge by clicking on Figures -
         













INTERPRETATION:  The rhythm is sinus at ~75/minute.  The PR, QRS, and QT intervals are normal.  There is RAD (predominantly negative QRS in lead I; positive in aVF).
  • Chamber Enlargement - The P wave is tall, peaked, and looks "uncomfortable to sit on" in lead II = RAA.  There is a deep negative component to the P wave in lead V1 = LAA. There is obvious voltage for LVH (the S in V2 plus the R in V5>>35).  We also suspect RVH (because of the presence of otherwise unexplained RAD in this patient who has multiple chamber enlargement).
  • Q-R-S-T Changes - are clearly consistent with LV "strain", especially in leads V5, V6 (asymmetric ST-T depression).  The fact that T wave inversion is so diffuse, tends toward being symmetric in leads I, aVL, V3 and V4 with ST coving and J-point depression in V5,V6 - suggests that ischemia may also be present.
CLINICAL IMPRESSION: We would interpret this ECG as showing sinus rhythm with RAD, LAA, RAA, probable RVH, and LVH with "strain" and/or ischemia (which is our way of acknowledging that strain and ischemia may coexist, and ST-T wave changes of one of these may mask the other . . . )Clinically - We strongly suspect a dilated cardiomyopathy given the multi-chamber enlargement.
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Note - Many use the terms LAA and LAE/RAA and RAE interchangeably.  We prefer LAA and RAA (left and right atrial Abnormality) in recognition of the fact that an abnormal-looking P wave will not always mean true atrial chamber "Enlargement".
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  • For more information on LVH - Check out this Web Page

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