ECG Case 253 Interpretation

This post is an answer to the ECG Case 253

  • Rate: 78 bpm
  • Rhythm: Regular Sinus rhythm
  • Axis: Normal
  • Intervals:
    • PR – Normal (~180ms)
    • QRS – Normal (100ms)
    • QT – 360ms (QTc Bazette 410 ms)
  • Segments:
    • Concave ST elevation in leads V2-4
    • No ST depression

  • Additional:
    • Voltage criteria for LVH
      • R wave V5 + S wave V1 ~35mm
      • R wave aVF >20mm
    • Narrow deep Q waves leads II, III, aVF, V4-6
    • Partial RBBB pattern – rSr’ in lead V1

Interpretation

Given the history of exertional syncope plus LVH with infero-lateral deep Q waves the major concern would be hypertrophic cardiomyopathy.

What happened next ?

The ECG changes were appreciated and the patient had a cardiology review and urgent echo. His echo was entirely normal and he was discharged with out-patient cardiology follow-up.

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