2. ID 279 – This 57 year old woman who had rheumatic fever at age 17 has been suffering from severe dyspnea and fatigue during the past year
3. ID 279 – This 57 year old woman who had rheumatic fever at age 17 has been suffering from severe dyspnea and fatigue during the past year Do you see P waves?
4. ID 279 – Normal sinus rhythm, 80/min Yes: The P waves originate from the sinus node– The rhythm is regular , the rate is 80/min. – Each P is followed by a QRS - The PR interval is normal – NORMAL SINUS RHYTHM, 80/min
5. ID 279 – Normal sinus rhythm, 80/min – Left atrial enlargement There are signs of left atrial enlargement
6. Let’s now look at the QRS complexes: There is Right axis deviation ID 279 – Normal sinus rhythm, 80/min – Left atrial enlargement – Right axis deviation
7. Let’s now look at the QRS complexes: There is Right axis deviation ID 279 – Normal sinus rhythm, 80/min – Left atrial enlargement – Right axis deviation
8. The QRS duration is normal : There is no right bundle branch block, left bundle branch block or non-specific block ID 279 – Normal sinus rhythm, 80/min – Left atrial enlargement – Right axis deviation
9. There is right ventricular hypertrophy ID 279 – Normal sinus rhythm, 80/min – Left atrial enlargement – Right axis deviation Right ventricular hypertrophy
10. There are no QRS signs of myocardial infarction ID 279 – Normal sinus rhythm, 80/min – Left atrial enlargement – Right axis deviation Right ventricular hypertrophy
11. There is ST depression with negative T waves in II, III, aVF and the right chest leads (V1-V3) , that may be due to RVH – There are also negative T waves in V4-V6. Diffuse T changes are not uncommon in patients who are in heart failure. They may be due to ischemia ID 279 – Normal sinus rhythm, 80/min – Left atrial enlargement – Right axis deviation Right ventricular hypertrophy
12. ID 279 – Final diagnosis: Normal sinus rhythm, 80/min – Left atrial enlargement – Right axis deviation Right ventricular hypertrophy with ST-T abnormalities
