ST Depression and T-wave inversion in V2 and V3.

A middle aged male dialysis patient was found disorganized and paranoid.  He had no chest pain or dyspnea.An ECG was recorded.  The clinician was worried about his ECG and showed it to me:What do you think?When I saw this ECG, I immediately recognized right ventricular hypertrophy as the cause of the ST depression and T-wave inversion in leads V2 and V3.  In other words, I was certain that this was achronicfinding on the ECG.  The worried clinician stated there are no old ECGs to compare with, and no records.  I remained certain that this was RVH as the findings are classic: Large R-wave in V1, large S-wave in lead I, and typical right precordial ST-T that mimic posterior STEMI. If the QRS were normal, and the patient had chest pain, I would have said this was posterior MI, or possibly hypokalemia (see this post: Are These Wellens ' Waves??).Later, however, we found written records from an outside hospital: EKG read:Normal sinus rhythmRight ventricular hypertrophy with repolarization abnormalityNonspecific T wave abnormalityProlonged QTAbnormal ECGNo significant change since 05-17-18Previous echoFinal Impressions:1. Normal LV size, moderately increased wall thickness, normal global systolic function with an estimated EF of 60 - 65%.2. Right ventricular cavity size is severely enlarged, global systolic RV function is severely reduced.3. Severely enlarged right atrium.4. Mildly enlarged left atrium.5. Severe tricuspid regurgitation.6...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs