tag:blogger.com,1999:blog-549949223388475481.post4132608626896514528..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: A healthy 30-something presented with nausea, vomiting, benign positional vertigo and atrial fibrillationUnknownnoreply@blogger.comBlogger2125tag:blogger.com,1999:blog-549949223388475481.post-30854026351498635942019-11-17T18:04:40.437-06:002019-11-17T18:04:40.437-06:00@ Mustafa — THANK YOU for your comment. I have alw...@ Mustafa — THANK YOU for your comment. I have always used an AGE qualification for the ECG diagnosis of LVH — such that SUM of deepest S in V1,V2 + tallest R in V5,V6 ≥35mm is ONLY valid IF the patient is at least 35 years of age. To emphasize — there is no “clear cut limit” (ie, on the day of one’s 35th birthday, it is not as if all of a sudden you “have LVH”) — but as it is generally known that younger adults often have increased QRS amplitude WITHOUT true chamber enlargement — I favor “reversing” these numbers (ie, using “53” instead of “35”) for this voltage criteria in a younger adult (NOTE: I do not have studies verifying use of this “53” criterion — instead, I base it on my 3+ decades of personal experience … with hope that this easy-to-remember criterion will reinforce the key concept that younger adults often have increased QRS amplitude without true chamber enlargement ). To emphasize — that IF there is “reason” for LVH in a younger adult (ie, known severe hypertension, cardiomyopathy, etc.) — and IF ST-T wave changes of LV “strain” ARE present — then 35mm is “more than enough” to qualify for the ECG diagnosis of LVH. Alas, we are told the “30-something” man in this case (ie, Who knows if he is older or younger than “35”?) was previously healthy — and there is no ST-T wave indication of LV “strain” on his ECG — therefore I felt the diagnosis of LVH by ECG was not justified. That said — ANY patient with new AFib should have an ECHO (You’ll note in My Comment above, that patients with Vagotonic AFib often have a normal Echo — but an Echo NEEDS to be done). P.S. I’ve provided info on “My Take” for the ECG diagnosis of LVH on a number of posts in Dr. Smith’s ECG Blog — Please CHECK OUT — June 15, 2019 — http://hqmeded-ecg.blogspot.com/2019/06/patient-with-dyspnea-you-are-handed.html — and also April 27, 2019 — http://hqmeded-ecg.blogspot.com/2019/04/is-this-terminal-qrs-distortion-is.html — Thanks again for your Comment! — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-73163084355264607912019-11-17T05:08:23.954-06:002019-11-17T05:08:23.954-06:00Thanks Dr Smith and Dr Grauer for the case and exp...Thanks Dr Smith and Dr Grauer for the case and explanation <br /><br />The ECG fulfills a criteria for LVH S wave in V2 + R wave in V5 almost 8 large boxes<br /><br />Is not it an indication for echo?<br /><br />Best regardsMustafa Alsmaelhttps://www.blogger.com/profile/05903823612170145696noreply@blogger.com