The underlying rhythm is atrial fibrillation.
Please realize that it MIGHTbe the superposition contributed by LVH combined with myocardial ischemia/infartion. This is an example illustrating the need to analyze ST depressions, ST elevations, T-wave inversion. These are consistent with and more nearly suggestive of “T-wave inversion of ischemia/infarction”. T-wave inversions are also present in V1, V2, V3, II, III, avF. We know that the LVH pattern will often exhibit ST depression and T-wave inversion, especially in Leads I, avL, V4, V5, V6 (lateral / high-lateral leads). Measured voltage in the precordial leads ……… R + S = 48 mm. SUMMARY FINDINGS OF THIS CASE STUDY TRACING This is grouped into the broad category of the Acute Coronary Syndrome consisting of: The non-ST elevation MI is typically exhibited by ST depression, T-wave inversion (especially in the associated leads), clinical chest pain and positive cardiac markers (CPK, CKMB, Troponin). Since the patient has LVH, some of the T-wave inversions and ST depressions in the lateral-highlateral leads (I, avL, V4, V5, V6) may be secondary to the LVH pattern, i.e. This is consistent with myocardial ischemia or infarction especially if the T-wave inversions are new. The tracing of this Case Study exhibits diffuseT-wave inversion. If the changes are new, this may dictate a needed aggressive treatment plan. Upon comparison, you may find these changes to be chronic and the patient may indeed need no treatment. The T-wave inversion has a wide range of interpretations with a partial list as follows: RBBB, LBBB, IVCD, Non-specific changes, Normal variant, Acute MI, Chronic Myocardial ischemia, Pericarditis, SAH, Digitalis effect and LVH to name a few.īecause of the multiple explanations of T-wave inversion, it is important to apply clinical correlation and a careful comparison with the old ECG. We will address the peaked T-wave in a later lesson. This lesson will focus on T-wave inversions. These are the two most common deviations from the Triad listed above and can represent a life-threat: Hence the need for comparison with the old cardiogram if available and clinical correlation. For example, if the T-waves are diffusely flat this could represent hypokalemia, but it could also be a benign variant and might be a chronic pattern for that patient. These observations might run the gamut of a benign normal variant, to secondary T’s associated with patterns such as LBBB, RBBB, LVH to the Acute MI. II, III, avF, etc) deviates from the above triad of characteristics, you must acknowledge this in your interpretation. If a given T-wave of a lead (especially if they occur in associated groups e.g. Exception are the T-waves of Leads V1, avL, III, avF (these might be inverted and yet the cardiogram may be perfectly normal). the normal T-wave is characterized as follows (as per agreement we will disregard lead aVR):Ĭlassic T-wave characteristics in ALL Leads: LESSON NOTE ON THE CHARACTERISTIC OF THE T-WAVEĪs you address the letter “ T” of the HEART acronym you must look at each lead’s T-wave to judge that it does or does not deviate significantly from its expected configuration i.e. T-wave inversion Leads I, avL, V1 through V6, II, III, avF.ST depression Leads V2, V3, V4, V5, V6 I, aVL, II, avF.Absent P-waves with irregularly irregular rhythm – atrial fibrillation.R + S = 48 mm - satisfies criteria of LVH.
SUMMARY OF SIGNIFICANT FINDINGS OF THIS ECG STUDY: ST-depression noted in Leads V2, V3, V4, V5, V6. Transition zone between Leads V2 and V3 is normal. QRS Duration = Normal | QT interval = Not applicable due to irregular QRS complexes