Orris
attachment

ECG finding

Reading File
Finding Sources
Finding Sources
Reading File
Finding Sources
Reading File
Loading Image
Based on careful analysis of the ECG image and the textbook material, here is a comprehensive interpretation:

ECG Findings — Interpretation

Patient: Female, 60 years old | HR: 90 bpm | Speed: 25 mm/sec | Gain: 10 mm/mV

Primary Finding: Left Ventricular Hypertrophy (LVH) with Strain Pattern

Rhythm & Rate

  • Sinus rhythm, rate ~90 bpm — regular

Voltage Criteria for LVH

  • Deep S waves in right precordial leads (V1–V2) combined with tall R waves in left precordial leads (V4–V6)
  • The Sokolow-Lyon criterion: SV₁ + RV₅ or RV₆ >35 mm — appears met on this tracing

Repolarization / Strain Pattern

  • ST-segment depression with asymmetric T-wave inversion in leads I, aVL, and the lateral precordial leads (V4–V6) — this is the classic LV "strain" pattern, reflecting repolarization abnormality in the hypertrophied myocardium

Axis

  • QRS axis appears normal to mildly leftward (~0° to –30°), consistent with LVH

P waves

  • Broad/notched P waves in inferior leads suggest possible left atrial abnormality (enlargement) — this further increases confidence in LVH diagnosis

Differential / Additional Considerations

FeatureSignificance
LV strain patternChronic pressure/volume overload (hypertension, aortic stenosis, HCM)
Left atrial enlargementOften co-exists with LVH due to elevated LV end-diastolic pressure
No pathological Q wavesNo evidence of prior MI
No bundle branch blockQRS appears <120 ms

Likely Underlying Etiologies

  1. Systemic hypertension — most common cause of LVH, especially in a 60-year-old female
  2. Aortic stenosis — pressure overload LVH
  3. Hypertrophic cardiomyopathy (HCM) — if asymmetric

Reference Diagram (Harrison's, Fig. 247-9)

LVH vs RVH ECG pattern diagram showing QRS changes in V1 and V6
LVH increases electrical forces directed left and posteriorly, with repolarization abnormalities causing ST depression and T-wave inversion in leads with prominent R waves — Harrison's Principles of Internal Medicine, 22E

Recommended Next Steps

  • Echocardiogram — to confirm LVH, assess wall thickness, LVEF, and diastolic function (more sensitive and specific than ECG)
  • Blood pressure assessment — hypertension workup
  • Clinical correlation with symptoms (dyspnea, chest pain, exertional syncope) to exclude aortic stenosis or HCM
Note: ECG voltage criteria for LVH have low sensitivity (~40–60%) but reasonable specificity. The combination of voltage + strain pattern increases diagnostic confidence. — Harrison's Principles of Internal Medicine, 22E, p. 1914–1915
This is a shared conversation. Sign in to Orris to start your own chat.