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Answer for May 10, 2013

The rhythm is sinus with a PVC at the beginning. Left axis deviation is present. There is a widened P wave in lead 2 with an 'm' shape, and a deep terminal component of the P wave in V1, both indicative of left atrial abnormality. LVH is present with tall R in V5 and "strain" T waves (more properly, ST-T repolarization abnormality). These T's have an asymmetric shape (slow down fast up), unlike ischemic Tw inversion which is usually more symmetric. Although LVH could be the cause of LAD, the q1S3 pattern and slight widening of the QRS may also suggest left anterior fascicular block as the etiology of the LAD.

NOTE: EKG's are for internal educational purposes of the University of Massachusetts Department of Family Medicine. Please do not forward without permission from Dr. Golding!


May 10 EKG