Practice ECG 6
Which atrium is enlarged? If you answered both of them, you were correct. There is a P-pulmonale morphology in II, and the biphasic P meets criteria for both RAE and LAE.
Is there any evidence of ischemia? If you look at the T waves in II and aVF, they are flipped, suggesting ischemia in the inferior leads. The Ts in the lateral precordials are also flipped and appear to be related to ischemia rather than LVH-with-strain pattern. Can you tell why? Because the T waves are symmetrical and they are not associated with any tall R waves.
This patient has LVH-with-strain pattern in the precordial leads. Lead II by itself has an S wave that measures 41 mm. In addition, there are some nonspecific ST-T wave changes noted.
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