Dr Gillani"s Blog: A 56 year old female with known history of hypertension presents to your clinic with fainting spells over the last 3 months.

Thursday 10 June 2021

A 56 year old female with known history of hypertension presents to your clinic with fainting spells over the last 3 months.

Her Blood pressure is 150/100 mmHg.

She does not take her antihypertensive medications regularly.

You ask for an ECG which is given below :

1 . What are the findings in the ECG?

2 . What is the most likely diagnosis ?

3 . What are the causes of this condition?

Answers given in comments section.

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Anonymized data and permission taken from patient for teaching purposes.

1 . What are the finding in the ECG :

The QRS complex in V1 is of QS morphology with no preceding R wave

There is “Appropriate discordance” in lead V1 with ST elevation and upright T wave

Appropriate discordance refers to the fact that abnormal depolarisation should be followed by abnormal repolarisation, which appears discordant to the preceding QRS complex.

Lateral leads with tall, broad R waves will often have associated ST-segment depression and T-wave inversion, and those with deep S waves can have an allowable amount of ST elevation that does not indicate ischaemia (generally viewed as < 25% of the size of the preceding S wave).

2 . What is the most likely diagnosis ?

Left Bundle Branch block most likely due to hypertension in this patient.

3 . What are the causes of this condition?

It is unusual for LBBB to exist in the absence of organic disease. Causes are varied and include:

Aortic stenosis

Ischaemic heart disease

Hypertension

Dilated cardiomyopathy

Anterior MI

Lenègre-Lev disease: primary degenerative disease (fibrosis) of the conducting system

Hyperkalaemia

Digoxin toxicity