Left Axis Deviation: LAHB

Report:

Atrial & sinus rhythm 76/min

Left atrial abnormality (LAA)

Left anterior hemiblock

Axis –40o

Early transition

Left ventricular hypertrophy with ST/T changes

Comment:

There is a typical qR and rS pattern in leads 1 and 3, respectively. Also there is a delayed intrinsicoid deflection in aVL, a small q in V2 and V3 and Rs in V6. The only thing missing is a secondary R wave in aVR; it is probably represented by the terminal slurring of the S wave.

LAHB increases the voltages in the limb leads (also increasing the LVH repolarisation changes) and tends to decrease them in the precordial leads. The LVH is true, however: the voltages are beyond what LAHB alone would produce.

The rhythm is reported as atrial but may well be junctional, with short PR interval and retrograde pattern in the frontal leads. She still had it a month later in the Cardiology Clinic (Fig 52a).

Fig 52a. I was relieved to see the terminal r waves in aVR. Abnormal intraventricular conduction shapes are far from constant, as shown by many examples in this volume. The early beat is probably junctional, with a tad of RBBB aberrancy and a retrograde P at its end. The preceding beat is sinus.

Fig 53. 84 year old man with ischæmic cardiomyopathy.