This 92-year-old patient was diagnosed with left bundle branch block on ECG, and left ventricular hypertrophy on echocardiogram. The two conditions are very often seen together, in fact, a majority of LBBB patients have LVH. Since the two conditions can have similar ECG changes, it is difficult from the ECG alone to determine the presence of LVH when LBBB is present. If the ECG criteria for LVH are present, it can be assumed that LVH is present, even in the presence of LBBB. For determining LVH by ECG criteria, the Sokolov-Lyon criteria are commonly used (
Left ventricular hypertrophy
This ECG is from a 50-year-old man with chest pain. Unfortunately, we don’t have any other clinical information. This tracing is a good example of widespread, symmetrical inverted T waves. Inverted T waves are present in Leads I, aVL, II, and V3 through V6. (The anterior-lateral leads). There are ST segment elevations in Leads V1 and V2.
This ECG was obtained from a 49-year-old man who was a patient in an Emergency Dept. We do not know his presenting complaint, only that he had a history of insulin-dependent diabetes mellitus (IDDM). It was noted by the donor of the ECG that the patient had no chest pain, no shortness of breath, and no other cardiac symptoms. We do not know his hydration or electrolyte status. There are quite a few interesting abnormalities on this ECG, and the exact interpretation would, of course, depend upon the patient's clinical status.
This ECG shows voltage criteria for LVH (deep S waves V1-V3 and tall R waves V4 - V6). There are many criteria in use for determining LVH, but probably the most commonly used is the Sokolow-Lyon criteria.
This strip offers something interesting for both your basic-level students and for your more advanced students. First, it is a good example of sinus rhythm with a premature beat. The PR interval was measured by the machine at .21 sec (218 ms). The premature beat is supraventricular - that is, it is not a PVC. Because of the slightly long PRI in this strip, it's P wave COULD be buried in the preceding T wave. That would make this a premature atrial contraction (PAC).
This is a good example of sinus rhythm with left bundle branch block. There is some irregularity due to a PAC at the beginning. The QRS is wide at 144 ms (.14 seconds). There is also first-degree AV block, with a prolonged PR interval of 228 ms. The criteria for diagnosis of left BBB are: wide QRS, supraventricular rhythm, and a negatively-deflected QRS in V1 with a positive QRS in Leads I and V6.
This ECG is from a man with left ventricular hypertrophy. LVH causes taller-than-normal QRS complexes in leads oriented toward the left side of the heart, such as Leads I, II, aVL, V4, V5, and V6. Leads on the opposite side, such as V1, V2, and V3, will have deeper-than-normal S waves.
This 60-year-old man presented to the Emergency Department with chest pain and shortness of breath. He gave a history of having seven coronary artery stents in the past.
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