Jason's Blog: ECG Challenge of the Week for March 3rd - 10th.
Patient's clinical data:
73-year-old white man.
LVH
Jason's Blog: ECG Challenge of the Week for July 22-29. What are the causes of these patterns?
I recently performed both of these ECGs a few days apart during the same work week. They were recorded on an outpatient basis. It wasn’t until I recorded the second ECG that I realized I had a good pair of ECGs to illustrate this comparison.
Left Ventricular Hypertrophy with Anterior Wall M.I.
This is a good ECG for demonstrating the voltage and ST criteria for LVH and acute anterior wall M.I. in the same patient, where both conditions have been confirmed by other tests. If you are teaching the topics of ST elevation M.I., or left ventricular hypertrophy, you will probably have to address the issue that LVH can be considered a "mimic" for STEMI, especially for beginners. This is because LVH causes ST depression in leads with upright QRS complexes, and reciprocal ST elevation in leads with negative QRS complexes. This is called ST segment discordance. The ST changes in LVH are due to the "strain" pattern, indicating strain on the left ventricular myocardium. It is true that some ST elevation will appear in V1 and V2 in these patients, and can be mistaken for M.I. In the ECG shown here, the patient has definite ST elevation in leads which would NORMALLY have depression in the LVH strain pattern. Leads V1 through V4 have ST elevation that is not discordant, and is definitely real. This patient was taken to the cath lab, and his left anterior descending artery stented.
