This was texted to me by a former resident. An 80-something woman who presented with chest pain and dyspnea.
This was texted to me. An 80-something woman who presented with chest pain and dyspnea.What do you think?The rhythm appears to be atrial fibrillation. In any case, it is clearly a supraventricular rhythm. There is significant ST depression in V2-V4. Is this posterior OMI?Before jumping to any conclusions about the significance of ST-T abnormalities, you must first be certain that they are not a result of (secondary to) any QRS abnormalities. Do you see any such abnormalities?There is a large R-wave in V1. Is this RBBB? No, it is not RBBB. The QRS is not wide enough, there are no wide S-waves in V5 and V6.Is it perhaps right ventricular hypertrophy (RVH)? Look for right axis deviation. Indeed, there is a deep S-wave in lead I: Right axis.This is RVH. And RVH often has such secondary repolarization abnormalities: STD in V1-V3, usually also with T-wave inversion.See these cases of RVH: Elderly woman w shortness of breath and an ECG that helps to understand itSo I texted back:" All the ST depression is due to RVH. See the right axis?? And R/S in V1> 1. (Large R wave in V1) "And he responded:" Ah yeah. That fits. Had big RV on my bedside US. Thanks!! " An old formal echo was found from 6 mo ago: Dilated right ventricle with septal flattening and estimated right ventricular systolic pressure of 70 mmHg (significant pulmonary hypertension). She ruled out for acute MI by troponins.&nbs...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Steve Smith Source Type: blogs
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