LVH with Right Axis Deviation
Report:
Atrial tachycardia (flutter) 208/min with 2:1 block
Axis +90o
Small voltage, limb leads
Left ventricular hypertrophy with ST/T changes
Comment:
The rate of the flutter is very slow, presumably due to flecainide therapy; it was only reported as flutter because it was faster previously and the isoelectric shelf is still characteristically effaced in the inferior leads.
The LVH is unusual in two respects: small limb lead voltage (QRS < 5 mm in all 6 leads) and right axis deviation +90o. They both express biventricular hypertrophy in this patient.
The patient had a proven COCM, with normal coronary angiogram. A similar ECG is in Case 29, in a transplanted heart, also with COCM. The combination may also indicate HOCM.
216. 83 year old diabetic in hyperosmolar coma and acute renal failure due to mesenteric gangrene
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