RVH with AF in COAD

Report:

Atrial fibrillation (coarse) with rapid ventricular response

Phasic aberrant conduction, probably incomplete RBBB (6th beat in aVR)

Right axis deviation

Right ventricular hypertrophy (RVH)

Probable left ventricular hypertrophy (LVH)

Comment:

This is a full picture of RVH, relatively rarely seen fully expressed in cor pulmonale due to COAD (CAL). The QR complex, with dominant R, in lead V1 is more often seen in patients with other causes of RVH, like congenital heart disease or primary pulmonary hypertension. The q wave may signify right atrial enlargement in this context177.

The deep S waves in the precordial leads may indicate a coexisting left ventricular hypertrophy.

Note that a left posterior hemiblock (LPHB) cannot be diagnosed on ECG grounds alone: RVH, which causes the right axis deviation here, has to be excluded on clinical grounds. The only (and obvious) exception is a new or intermittent LPHB.

The QRS is characteristically narrow.

249. Holter strips on 83 year old man with aortic stenosis and colonic bleeding, found dead in his hospital bed

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