Lead 2 Monitoring
Report:
Sinus rhythm
P wave axis -30o
Probable left ventricular hypertrophy
Comment:
Lead 2 was once the traditional monitoring lead. This was based on the fact that, if the P waves were - as they usually are - positive in all three standard leads, lead 2 P waves will be the largest: L2 = L1 + L3 algebraically. The problem starts with negative P waves in L3, which diminish or, as here, completely iron out the P wave in L2. It is even worse for ascribing FLBs to RBBB, LBBB, or VEBs, as eloquently stated by Marriott181. A similar flat P wave is shown in Case 159.
Why the rhythm strip worried the Life Insurance doctor can probably be best understood by thinking which doctors do this kind of work.
The diagnosis of LVH is based on RV6 > RV5, an insensitive, but surprisingly specific sign182. The upright T waves may indicate an early stage of LVH, or left ventricular volume overload. Maybe that negative P wave in lead 3 wasn’t there for nothing: it may be a sign of LAA.
If you have any suggestions for or feedback on this report, please let us know.
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