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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