Case A4. Old Inferior Infarction; Left Ventricular Hypertrophy. St Emlyn’s ECG Library.

stemlyns, ECG Library, #FOAMed, St. Emlyn’s ECG Library. http://www.stemlynsblog.org/ecg-library/History

The EGG was recorded from a 65 year old woman with diabetes. She had been hypertensive for several years and she had known CKD 3. The EGG was recorded following the onset of angina. There was no history of previous pain suggestive of infarction.

EGG

There are pathological Q waves in leads II, III and aVF. This indicates previous inferior infarction. The height of the R waves in leads V4 and V5 is greater than 27mm and the sum of the R wave in V5 and the depth of the S wave in lead VI exceeds 35mm. The ST segments are downwards sloping or depressed in the leads that face the left ventricle: I, aVL and V4, V5 and V6. These changes fulfil the criteria for the diagnosis of left ventricular hypertrophy. There is an isolated ventricular premature beat in the rhythm strip.

Comment

Inferior infarction has taken place although the timing cannot be determined from this EGG. The voltage changes are those of left ventricular hypertrophy that may have been caused by longstanding hypertension in this case. The ST/T changes may be associated with the left ventricular hypertrophy present and cannot be used to diagnose ischaemia.

Myocardial infarction may be painless or accompanied by relatively little pain; this occurs more commonly in the elderly and in diabetics.

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