Ken Grauer, who is truly an ECG guru, also had a hand in the analysis of this ECG. Visit his extremely informative site here: ECG Interpretation
There is borderline sinus tachycardia.
The R waves in V1 are abnormally tall, with R/S ratio greater than 1.
There are also deep (though narrow) Q waves in I, aVL, V5, and V6.
Several conditions can cause the increased R/S in V1:
- WPW? But no delta waves to suggest WPW.
- Posterior MI? But young age, and no supportive ST/T changes in V1-V3.
- (I)RBBB? But no no rSR’ pattern in V1, no deep lateral S waves
- RVH? But no S waves in I, aVL, or V6, and no right axis deviation or right atrial abnormality
- Hypertrophic Cardiomyopathy (HOCM) with Septal Hypertrophy – voltage is inadequate
- Lead Misplacement – checked and ok.
In fact, records revealed that he is known to have Duchenne muscular dystrophy.
|From Slucka. Type “a” was most common, seen in 64/106 DMD patients.|
The tall R waves in V1 and the deep lateral Q waves are thought to reflect myocardial fibrosis in the posterobasal and lateral myocardium. Although these changes represent disease progression in the myocardium, they have not been shown to be age-related, perhaps because ECG changes occur quite early in life, proceeding clinical or echocardiographic signs. Although DMD patients do develop a progressive and inevitable left ventricular cardiomyopathy, the classic ECG changes do not seem to be correlated with echo findings (such as reduced EF or increased LV size), or with the presence of dilated cardiomyopathy.
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