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Dr. Andrew Rynne

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ECG said abnormal R-Wave progression, LVH. What does it indicate?

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Dr. Raja Sekhar Varma

Cardiologist, Interventional

Practicing since :1996

Answered : 192 Questions

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Posted on Tue, 8 Jan 2013 in Hypertension and Heart Disease
Question: I am over weight and rather out of shape. Yesterday I went for a walk on the beach and felt out of breath a bit light headed, a pain behind my throat. I must say my stomach was rather upset as well.. Some sort of discomfort below my diaphragm very similar to what one would feel around his abs after doing some set ups after having not done so for ages.. I decided to visit the emergency room just in case the ECG came as follow :
Rate : 71
PR: 167
QRSD : 103
QT: 377
QTc: 410

AXIS
P 20
QRS 3
T 12

12 Lead : Standard Placement

I read:
- Sinus Rhythm normal P axis, V-rate 50 99
- Abnormal R-Wave progression, early transition QRS area > 0 in V2
- Left Ventricular hypertrophy multiple voltage criteria

The emergency D decided to do some blood work , the results were:
CK-MB (MASS) 0.6 NG/ML REF RANGE 0-10.4
TROPONIN I (QUANTITATIVE) 0.000 NG/ML REF RANGE cut-off value = 0.40
AMYLASE 26.50 U/L REF RANGE 28-100

D-DIMER(QUANTITATIVE ELFA) 100 NG/ML (FEU) REF REANGE < 300

I am worried about that LVH is a QRSD of 103 an indication of something serious.

I would also like to add that 3 years ago I did experience the same. Went to the ER they said LVH kept me in then I signed a waiver to go home and go to my dr next day.. the ECG was normal this time ! I insisted to go and have an echogardiogram the dr said I was OK. I do have some mitral regurgitation. the Dr said it was not a concern.. What do you suggest? Thanks
doctor
Answered by Dr. Raja Sekhar Varma 6 hours later
Hello Mr XXXXXXX
Thank you for the query.

The breathing difficulty and the discomfort that you experienced could be related to the fact that you are overweight and out of shape physically. Since the ECG during the episode did not show any ischemia and since the cardiac enzymes were negative, you did not have any acute heart attack at this point of time.

The ECG can show left ventricular hypertrophy if you have high blood pressure, or if there is a blockage of aortic valve or if there is any abnormal increase in the thickness of the left ventricle (hypertrophic cardiomyopathy, etc.). This can also happen if there is ventricular enlargement due to leakage from the mitral valve.

The echocardiogram can actually identify the presence and extent of LVH, as also determine a likely cause for the same. The echo will also determine the exact severity of mitral regurgitation, its cause and whether any specific treatment is required for the same.

You should also get your blood pressure checked and confirm that the value is less than 140/90 mmHg.

I would also recommend that you do a treadmill stress test, which will document your exercise capacity and also test for the likelihood of any blockages in the coronary arteries.

In addition, please consider doing a fasting lipid profile and a fasting blood sugar (if not done recently).

The specific treatment that you require will depend on the results of the above investigations. Generally, you should work towards reduicng weight. Diet is very important. Also, plan a daily exercise regimen which will improve the tone and strength of the muscles and the endurance capacity. Aerobic and dynamic exercises are beneficial for the heart, like walking, jogging, swimming, cycling, etc.

I hope this answers your query. Feel free to ask me for any further specific clarifications that you may require.

With regards,

Dr Raja Sekhar Varma, MD, DM
Consultant Interventional Cardiologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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