ECG Guru - Instructor Resources - LVH with normal axis https://www.ecgguru.com/ecg/lvh-normal-axis en Jason's Blog: ECG Challenge of the Week for July 22-29. What are the causes of these patterns? https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-july-22-29-what-are-causes-these-patterns <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/jasons-blog-ecg-challenge-week-july-22-29-what-are-causes-these-patterns"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201e-1a%20answer.png" width="765" height="509" alt="" /></a></div><div class="field-item odd"><a href="/blog/jasons-blog-ecg-challenge-week-july-22-29-what-are-causes-these-patterns"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201e-2a%20answer.png" width="765" height="644" alt="" /></a></div><div class="field-item even"><a href="/blog/jasons-blog-ecg-challenge-week-july-22-29-what-are-causes-these-patterns"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201e-2b%20answer.png" width="765" height="631" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>&nbsp;</p> <p><span style="font-size: small;">I recently performed both of these ECGs a few days apart during the same work week.&nbsp; They were recorded on an outpatient basis.&nbsp; It wasn’t until I recorded the second ECG that I realized I had a good pair of ECGs to illustrate this comparison.</span><br><br><span style="font-size: small;">At a superficial glance, both of these appear to represent the same thing and some people&nbsp;might even argue that both of these ECGs have identical interpretations but they would be wrong.&nbsp; One of these represents a conventional example that is <em>intrinsic</em> to the heart and it's conduction system.&nbsp; The other is a lesser-known example and is <em>extrinsic</em> to the heart.&nbsp; Admittedly, they do share similar characteristics however there are several contrasting features as well.<span class="MsoNormal">&nbsp;</span> </span><br><br><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;"><span style="color: blue;">Fig. # 1</span></span></strong> </span><br><br><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;"><span style="color: #c00000;">Patient's clinical data:</span></span></strong> &nbsp;68-year-old white man.&nbsp; </span><span style="font-size: small;">History of hypertension.</span><br class="MsoNormal"><br><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;"><span style="color: blue;">Fig. # 2</span></span></strong></span><br><br><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;"><span style="color: #c00000;">Patient's clinical data:</span></span></strong>&nbsp; 57-year-old black man. </span><br><br><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;">The computer interpreted <span style="color: blue;">Fig. # 2</span> as:</span></strong></span></p> <table class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-yfti-tbllook: 1184; mso-padding-alt: 0in 5.4pt 0in 5.4pt;" border="1" cellspacing="0" cellpadding="0"> <tbody> <tr style="mso-yfti-irow: 0; mso-yfti-firstrow: yes; mso-yfti-lastrow: yes;"> <td style="width: 6.65in; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt;" valign="top" width="638"> <p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: small;">Marked sinus bradycardia with marked sinus arrhythmia 1st degree AV block</span><br><span style="font-size: small;">Voltage criteria for left ventricular hypertrophy</span><br><span style="font-size: small;">Abnormal ECG</span><br><span style="font-size: small;">When compared with ECG of <em style="mso-bidi-font-style: normal;">(deleted)</em></span><br><span style="font-size: small;">PR interval has increased</span></p> </td> </tr> </tbody> </table> <p class="MsoNormal"><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;">DO YOU AGREE WITH THE COMPUTER?</strong></span><br><span style="font-size: small;"><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;"><span style="line-height: 115%; color: #009900;"><br>QUESTIONS:</span></span></strong>&nbsp; </span></p> <p><span style="font-size: small;"><span style="line-height: 115%;">What are the causes of the pauses and the "group beating"?&nbsp; Do either of these patients need a pacemaker?</span>&nbsp;<span style="line-height: 115%;"> <br><br><span style="text-decoration: underline;"><strong>Hint:</strong></span>&nbsp; In <span style="color: blue;">Fig. # 2</span>, pay careful attention to the sinus P-P intervals and their correlation with the timing of the pauses.&nbsp; Compare the <em style="mso-bidi-font-style: normal;">PR intervals</em> and their corresponding <em>RP intervals</em>.&nbsp; Also contrast the lengths of the longest and shortest RR intervals. &nbsp;This will help to differentiate it from <span style="color: blue;">Fig. # 1</span>.</span></span></p> </div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/111/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for July 22-29. 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What are the causes of these patterns? 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >2.7</span></span> <span class="total-votes">(<span >3</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-9iUM5OQGi6kl_ptVeOhboIBsyKO8r8_67-IOZCuGoK4" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fblog%2Fjasons-blog-ecg-challenge-week-july-22-29-what-are-causes-these-patterns&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20of%20the%20Week%20for%20July%2022-29.%20%20What%20are%20the%20causes%20of%20these%20patterns%3F"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Sun, 22 Jul 2012 05:09:42 +0000 jer5150 253 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-july-22-29-what-are-causes-these-patterns#comments Left Ventricular Hypertrophy With Normal Axis https://www.ecgguru.com/ecg/left-ventricular-hypertrophy-normal-axis <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/left-ventricular-hypertrophy-normal-axis"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/LVH103_0.png" width="1800" height="1146" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This ECG is from an elderly man with long-standing hypertension. It is a good example of LVH, with tall QRS complexes in the left-sided leads (V5, V6) and deep QRSs in right sided chest leads V1 and V2), but a rather unusual axis, in that it is normal, and we often seen left axis deviation with LVH. His hypertrophy is not severe as seen on imaging studies, but he shows an obvious "strain" pattern of sloping ST depression and T wave inversion in leads with upright QRS complexes. The signs of LVH are subtle, but when viewed as a whole ECG, the pattern seems more obvious. Always consider body shape, also, as a very thin person may produce more voltage on the ECG since the electrodes are close to the heart, and a person with a large chest may seem to minimize the QRSs, as we sometimes see with COPD. For more discussion of LVH criteria, go to the "Favorites" page. Every ECG blogger on the blogs list will have a discussion of LVH criteria and significance.</p> </div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/111/feed" method="post" id="fivestar-custom-widget--2" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--4" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Left Ventricular Hypertrophy With Normal Axis 1/5</option><option value="40">Give Left Ventricular Hypertrophy With Normal Axis 2/5</option><option value="60" selected="selected">Give Left Ventricular Hypertrophy With Normal Axis 3/5</option><option value="80">Give Left Ventricular Hypertrophy With Normal Axis 4/5</option><option value="100">Give Left Ventricular Hypertrophy With Normal Axis 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3</span></span> <span class="total-votes">(<span >1</span> vote)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--2" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-vlaa39SOSBNsEnqH0C9tC9kWIe0ajDsVyOpD9ocMrAs" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/left-ventricular-hypertrophy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left ventricular hypertrophy</a></div><div class="field-item odd"><a href="/ecg/normal-axis" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Normal axis</a></div><div class="field-item even"><a href="/ecg/lvh-normal-axis" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">LVH with normal axis</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_2"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fleft-ventricular-hypertrophy-normal-axis&amp;title=%20Left%20Ventricular%20Hypertrophy%20With%20Normal%20Axis"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Wed, 18 Apr 2012 17:41:00 +0000 Dawn 199 at https://www.ecgguru.com https://www.ecgguru.com/ecg/left-ventricular-hypertrophy-normal-axis#comments