LVH & RBBB
Report:
Sinus rhythm 78/min
Left atrial abnormality
Third degree AV block
Ventriculophasic sinus arrhythmia
Junctional rhythm 42/min
Right bundle branch block
Left anterior hemiblock
Frontal axis – 40o
Left ventricular hypertrophy with ST/T changes
Comment:
This is a typical LAHB: large frontal plane voltages, no secondary R waves in the inferior leads, R in aVR later than in aVL, RS in V6. The RBBB is relatively modest. It is more conspicuous in conducted sinus rhythm (Fig 282a below). The complexes often look slightly different in junctional rhythm – the “non-phasic” aberrancy of Schamroth’s. This lady was the oldest true HOCM I’ve seen; she was bright and well preserved. Survival to her age means she is good material.
Fig 282b is another example of LVH (voltage only) and more pronounced RBBB, with normal axis (Fig 282b). The patient is an 84 year old lady, in the Outpatients, with concentric LVH but no ST/T changes.
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