ECG Case 041

by Dr Ed Burns, last update March 19, 2019

70-year old patient presenting with acute pulmonary oedema. Describe the ECG

Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

This is an ECG example of dilated cardiomyopathy demonstrating signs of enlargement of all four cardiac chambers:

There is marked LVH with very deep S waves in V2-4.
Right axis deviation suggests associated RV enlargement (= biventricular enlargement).
Evidence of left atrial enlargement (deep, wide terminal portion of the P wave in V1).
Peaked P waves in lead II suggestive of right atrial enlargement (~ 2.5mm in height).

This patient had four-chamber dilatation on echocardiography with severe congestive cardiac failure (awaiting cardiac transplantation).

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