McGill Case 197

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This case report is kindly provided by Michael Rosengarten from McGill and is part of the McGill Cases. These cases come from the McGill EKG World Encyclopedia.

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The rhythm is not clear. It could be sinus with very flat P waves (there are prominent U waves that make it difficult to see P waves) or perhaps nodal rhythm, with most likely ventricular premature complexes. There is a right axis deviation of the QRS and tall R waves in V5 (> 35mm) with wide spread ST changes. The EKG suggest left ventricular hypertrophy with possibly a left posterior fascicular block.