LVH Voltage Despite Old Infarctions

Report:

Sinus rhythm 92/min

PR interval 0.20”

LVH voltage (RL1 >20 mm, etc)

Old anterior infarction

Old inferior infarction

Comment:

Although the commonest cause of small voltage are large or multiple infarctions, the latter may coexist with large voltages. In this example, these are confined to the frontal leads, without any confounding hemiblocks: a true LVH. There are some ST/T changes, too – ST depression and small T waves, but they are often discounted if minor and in the presence of obvious other pathology, viz. LVH and infarcts.

The anterior infarct is of the relatively uncommon variety, a localised anterior infarction, with R waves on either side of it (which, undoubtedly, would be bigger without the infarction).

One of myocardial responses to localised injury is hypertrophy elsewhere; of course this patient could have had a pre-existing LVH from, e.g., hypertension.

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