ECG of the Month

What does this tracing show?

a) Right ventricular hypertrophy
b) Acute posterior myocardial infarction

 

Correct answer:
a) Right ventricular hypertrophy

Discussion:
In this tracing, the QRS axis tends to the right axis deviation (RAD), which should make one think of right ventricular hypertrophy (RVH) first. After the RAD, all other diagnostic features of RVH are found in the precordial leads—namely tall R waves in the right precordial leads, a deep S wave in V6, and downsloping ST-T changes that are more prominent in the right precordial leads. This tracing has all of these features and is from a patient with primary pulmonary hypertension with RVH. In a tracing of acute posterior myocardial infarction, the ST segment is depressed more horizontally, and RAD and a deep S wave in V6 are not part of it.

source : The Heart.Org