Emphysema: α-1 Antitrypsin Deficiency

Report:

Sinus rhythm

Left axis deviation – 80o

Comment:

The commonest cause of LAD is LAHB; in middle-aged men, the commonest cause of LAHB is underlying coronary disease, often subclinical. This trace looks like LAHB, down to QR in aVR and RS in V6. True, Lead 1 does not show an initial Q wave, but the whole complex is small and qR in that lead is not an essential requirement for LAHB.

What makes this more likely to represent “axis illusion” of emphysema than LAHB is the following: (a) the patient had known severe emphysema, from α-1 antitrypsin deficiency; (b) the S wave is deeper in Lead 2 than in Lead 3; (c) the peak of R wave in aVR is not delayed with respect to peak of R wave in aVL93.

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