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Figure 12.9 shows two electrocardiogram records from a patient. Record B was taken one year after record A was obtained. In these records:
- The QRS axis in A is directed to the left rather than to the right of vertical.
- The QRS complexes V1, V4 and V6 in A suggest left, rather than right, ventricular hyper-trophy
- The change from A to B suggests a return towards normality.
- The QRS axis in B is directed downwards rather than upwards.
- The inversion of T in leads III and V1 in record A indicates myocardial ischaemia.
Medicine
a. False The net QRS in lead I is negative, indicating an axis to the right rather than the left; this is confirmed by lead III having a large positive deflection.
b. False The R dominance in V1 and the prominent S wave in V4 suggest an abnormally great contribution from the right ventricle in these leads.
c. True In record B, V1 now shows a normal S wave; V4 has lost its S wave to show only a normal R wave.
d. True It is roughly 60o below the horizontal (close to the axis of lead II). The swing from right (A) to left (B) indicates return of left ventricular dominance, as do the V lead changes.
e. False Occasional T wave inversion is common and usually has no sinister significance
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