LVH – Volume Overload Pattern

Report:

Sinus rhythm 65/min

Left atrial abnormality

Left ventricular hypertrophy, volume overload pattern

RSR’ in V1-2

Comment:

The LAA is best seen in V3-5, along with prominent T waves. With LVH voltage in the chest leads this constitutes evidence for LV volume overload, from any cause. This patient had severe aortic and mild mitral incompetence.

The RSR’ pattern is not reflected in any S waves in 1 or V6: it’s unlikely to be an incomplete RBBB. Even if it were, it is a normal variant. So why report it? Just in case... One does not know the diagnosis reporting routine ECGs. She was only 51; there could have been an ASD, when RSR’ would be of significance.

When, on another occasion, she was in heart failure precipitated by atrial fibrillation, the ECG evidence for LVH was not there (Fig 85a). Fluid accumulation and retention diminishes the voltages.

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