EKG Fileroom Case 3

Diagnosis: NSR with first degree AV block, Right axis deviation, Right ventricular hypertrophy

Discussion: This patient has COPD and therefore probably longstanding pulmonary hypertension. This causes the RV to hypertropy and give you Right axis deviation. To dx RVH we look at the R to S ration in lead V1 which is greater than 1. Also the axis is extremely rightward. A finding that is often also present in cases of pulm HTN but not here is right atrial enlargement, due to stretching of the right atrium. Note that this stretching can cause supraventricular arrythmias.

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note: The explanations contained here are based upon my own understanding of Electrophysiology as a 4th year medical student. I am pretty sure I am right, but if you have more to add, comments, questions or corrections please email me.