ECG Case 087

36yr old male presented to the Emergency Department with a non-cardiac issue but an ECG was performed due to a pre-existing cardiac history.

ECG Case 087 LITFL Top 100 EKG

Describe and interpret this ECG



  • ~115 bpm


  • Regular
  • Sinus Rhythm


  • Normal


  • PR – Normal (~160ms)
  • QRS – Normal (100ms)
  • QT – 320ms


  • ST elevation leads aVR (<1mm), V1 (1mm), V2 (2mm)
  • ST depression lead I


  • Biphasic T wave leads aVF & V3
  • T wave inversion leads I, II, aVL and deep inversion leads V4-6
  • Voltage criteria for LVH
    • S V2 (25mm) + R V6 (20mm)
  • R wave peak time in leads V5 & V6 ~60ms
  • P waves wide with deep terminal deflection in lead V1 with notching in lead II


  • Sinus tachycardia
  • ECG features for:
    • LVH
    • LAE
  • Deep anterolateral T wave inversion

Broad differentials

These ECG features could be seen in a wide range of conditions and include:

  • Ischaemia
  • Myocarditis
  • Acid-base / electrolyte disturbance
  • Raised ICP


The key to interpretation of any ECG, or any test for that matter, is looking at the test and then taking it back to the patient in question.

In this case we have a young male with no acute cardiac complaint, i.e. nil chest pain, dyspnea, and a known cardiac condition. Given these factors the most likely cause is apical hypertrophic cardiomyopathy (AHCM) given the absence of Q waves and deep T wave inversion in the precordial leads, this patient did in fact have known apical hypertrophic cardiomyopathy.

You can read more about apical hypertrophic cardiomyopathy in the links below:

TOP 100 ECG Series

Emergency Medicine Specialist MBChB FRCEM FACEM. Medical Education, Cardiology and Web Based Resources | @jjlarkin78 | LinkedIn |

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