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This post is an answer to the ECG Case 334

• 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 in V5-6 with T wave inversion
  • Features suggesting additional RVH
    • Deep S wave in V5
    • Biphasic high-voltage complexes in 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.

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

SIMILAR CASES:

• ECG Case 103: Left ventricular hypertrophy (LVH)
• ECG Case 106: Left Atrial and Left Ventricular Hypertrophy (LVH)
• ECG Case 56: Left Ventricular Hypertrophy (LVH) from Aortic Stenosis