Left Ventricular Diastolic (Volume) Overload

Report:

Sinus rhythm

Left atrial abnormality

First degree AV block

Early transition

Left ventricular hypertrophy, volume overload type

Comment:

The upright T waves tend to remain upright for a long time on volume overload LVH; eventually they come down. At early stages they are even taller than normal, especially in V5-6; here they are within normal limits. They are characteristically pointed (“arrowhead”), as here. Another distinguishing feature of diastolic overload is the preservation of septal q waves in the left precordial leads (pressure overload tends toward incomplete LBBB). The R wave height is also greater in volume overload LVH76.

Early transition is characteristic of both types of LVH. It is prominent in this trace, with transition in V2.

108. Two week old girl, centrally cyanosed

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