Morning Report: 12/5/2013

The Case:

Definition:

How?:

HTN

Aortic Stenosis

Coarctation

HCOM

Mitral Regurg

Aortic Regurg

Why do we care?

ECG findings of LVH

Basics:

Thick-walled LV causes increased R wave amplitude in left-sided leads.
Conversely, deep S waves in right-sided leads
Thick-walls cause prolonged depolarization (increased time to peak of R) and abnormal repolarization (strain pattern?)

Voltage Criteria:

There’s a billion
Amal Mattu condenses them into
- S wave in V1 + R wave in V5-6 > 35mm
- Any S + any R > 45mm
- An R wave > 11mm in AVL

Non-Voltage Criteria

Time to R wave peak > 50ms
ST depressions and T wave inversions in lateral leads
- Characteristic morphology: ST depressions are diagonal and down-sloping
- Inverted T waves are very assymetric

NB* ECG criteria for LVH are only 50% sensitive!

Other findings commonly associated with LVH

LVH causes STE and ST Depressions!?!?!

How to distinguish LVH from STEMI?

It’s not easy.
Use caution
Look out for horizontal ST depressions and symmetric inverted T waves.

When in doubt, get old and serial ecgs!

Have a low threshold to call cards.

Acknowledgements:

http://ekgumem.tumblr.com/
http://lifeinthefastlane.com/
WILLIAM B. KANNEL, TAVIA GORDON, WILLIAM P. CASTELLI, JAMES R. MARGOLIS; Electrocardiographic Left Ventricular Hypertrophy and Risk of Coronary Heart DiseaseThe Framingham Study. Annals of Internal Medicine. 1970 Jun;72(6):813-822.