ECG library
LVH with a strain pattern
advancedDecades of untreated hypertension; the clinic ECG prompts a phone call about 'possible ischemia'.
25 mm/s · 10 mm/mV · synthetic tracing
100%
Calipers:2000 ms50.0 small boxes30 bpm if R-RDrag the orange markers. One small box = 40 ms.
Key findings
- LVH by voltage
- Down-sloping lateral ST depression with asymmetric T inversion
- Repolarization changes SECONDARY to depolarization changes
Learning points
- Strain is the classic ischemia mimic: asymmetric, down-sloping, lateral, and stable across old ECGs. Compare with priors before activating anyone.
- New or symmetric T inversion on top of LVH still earns an ischemia workup; strain explains the chronic pattern, not a new one.
- The finding's real message is end-organ damage: this heart has been paying for the blood pressure for years.
Connected