McGill Case 314

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. Previous Case: McGill Case 313 | Next Case: McGill Case 315

An 84 year old lady with hypertension There are a number of abnormalities here. left anterior hemiblock QRS axis more left than -30 degrees initial R wave in the inferior leads (II, III and aVF) absence of any other cause of left axis deviation left ventricular hypertrophy In the presence of left anterior hemiblock the diagnostic criteria of LVH are changed. Rosenbaum suggested that an S wave in lead III deeper than 15 mm as predictive of LVH. long PR interval (also called first degree heart block) PR interval longer than 0.2 seconds left atrial hypertrophy M shaped P wave in lead II P wave duration > 0.11 seconds terminal negative component to the P wave in lead V1 with permision from the site of Dr. Dean Jenkins