TALL PEAKED R WAVES -EKG EXAMPLE No2

This is the EKG of a 75 year old man who was hospitalized for amputation of his right leg due to peripheral ischemic disease.(PAD)

Personal medical history includes
Coronary artery disease which required PCI 5 years ago
Heart failure with reduced ejection fraction due to ischemic disease (EF=35%)
Prosthetic (biologic) aortic valve performed 7 years ago
Peripheral ischemic disease in the contralateral leg

EKG analysis

• 1.Sinus rhythm.Every QRS complex is preceded by a P wave.Exception is the 9th QRS complex which is not preceded by  a P wave.It also appears prematurely and is followed by a pause.Furthermore it is noted that it is wide (QRS>0.12msec) with a different morphology that the rest (rSR - right bundle branch morphology)

• 2.Left anterior hemiblock (LAH) - note that the QRS complex is negative in II

• 3.Right Ventricular Hypertrophy -dominant R wave in V1

• 4.Left Ventricular Hypertrophy -R in aVL greater than >11mm

• 5.Old inferior myocardial infarctwaion - Q waves in III and aVF

• 6.No current ischaemia is noted