LVH Voltage: Mitral Incompetence

Report:

Sinus rhythm

VEB

Left ventricular hypertrophy voltage

Comment:

The voltage criteria are present in both the frontal and the precordial leads, making a false positive diagnosis of LVH unlikely. In the frontal leads, R wave in Lead 2 is considerably over the required 15 mm. The heart position is vertical; otherwise 1 and aVL would probably meet the voltage criteria. By convention, this early stage of LVH is reported as LVH voltage. If repolarisation abnormalities were present, even if not due to LVH, the report would be LVH with ST/T changes.

There is no evidence of increased P-terminal force (PTF) in V1 , although borderline notching can just be made out in V2. The diagnosis rests with voltage only. Electrocardiographically, this could be a case of volume overload (diastolic overload) LVH from, e.g., aortic or mitral incompetence: its T waves stay upright for longer. In V4 they are characteristically tented. This is of course what it was: the patient had Grade 4 non-rheumatic mitral regurgitation and his LV function was starting to deteriorate.

Postoperative trace with pericarditis pattern is shown below (Fig 166a). Note the ST segment depression in rS lead V1, common in all acute pericarditis.

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