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This post is an answer to the ECG Case 350

• Rate: 66
• Rhythm: regular sinus rhythm
• Axis: normal
• Intervals:
  • PR – Normal (~200ms)
  • QRS – Normal (80-100ms)

• Additional:
  • Voltage criteria LVH
    • Lead V5 and 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 in leads I, II, III, aVF, V4-6
    • T wave inversion in leads I, II, III, aVF, V4-6
  • Deep Q waves in 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.

READ MORE: Left Ventricular Hypertrophy (LVH): How to Recognize it on ECG [With Examples]