ECG of the Week – 5th March 2018 – Interpretation

The following ECG is from a 35 yr old male who presented to the Emergency Department following a brief episode of atypical chest pain.


Click to enlarge


  • 66


  • Regular
  • Sinus rhythm


  • Normal


  • PR – Normal (~200ms)
  • QRS – Normal (80-100ms)


  • Voltage criteria LVH
    • Lead V5 & V6 R > 26mm
    • S V1 + R V5 or V6 > 35mm
    • R wave in aVF > 20 mm
    • S wave in aVR > 14 mm
  • Non-voltage LVH criteria
    • LV ‘Strain’ Pattern
    • ST Depression leads I, II, III, aVF, V4-6
    • T wave inversion leads I, II, III, aVF, V4-6
  • Deep Q waves leads V4-6
  • Voltage criteria for LVH with secondary ST segment and T wave changes

 Whilst voltage criteria for LVH can be a normal variant especially in young fit patients this should not be associated with Q waves or secondary ST / T changes.The presence of LVH with Q waves and / or ST / T wave changes in a young patient is concerning for potential hypertrophic cardiomyopathy (HCM) and requires further investigation and referral to cardiology team. This patient had known HCM and is awaiting a septal myectomy. 

References / Further Reading
Life in the Fast Lane


  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.

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