LVH Voltage: RV6 > RV5 and Its Variability
Report:
Atrial fibrillation with ventricular response approx. 90/min
RSRâ V1
Ashmanâs phenomenon
Left ventricular hypertrophy voltage
Comment:
In normal subjects, and even in LVH, the tallest precordial R wave is V5. If it is in V6 â in the absence of anterior infarction â it is a reasonably specific sign of LVH, or at least cardiomegaly.
The rSrâ morphology in V1 with, if anything, narrow QRS like here is not normally reported. It is mentioned here because its plumper relative, the rsRâ, appeared as a good example of RBBB-type phasic aberrant conduction, the Ashmanâs phenomenon. There is a typical long-short sequence, typical RBBB morphology and typical absence of any attempt at a pause (even in AF) after the broader complex: these, practically, exclude a VEB from differential diagnosis.
At another time, this patient had LVH voltages with the tallest R wave in V5. There is a lesson here: LVH voltages vary (partly of course from lead positioning in the case of precordial leads48) but, overall, the diagnosis of LVH tends to remain49.
61a. Tallest R wave is now in V5. 62. Cyanosed 47 year old lady with Turnerâs syndrome
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