ECG Case: 52-year-old Man with Shortness of Breath

by Joseph Alpert, MD

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    00:01 So let's do some cases.

    00:02 A 52-year-old man comes to the emergency department complaining of shortness of breath whenever he walks.

    00:10 He says he was once told he had high blood pressure but he didn't particularly like his doctor so he never did anything about it.

    00:18 His physical exam shows very impressive high blood pressure, a 190/108.

    00:24 His heart rate is quite fast at 96 bpm.

    00:26 And the rest of his physical exam shows signs of early heart failure.

    00:30 He might have crackles at the base, his JVP -- his jugular venous pulse might be elevated so there's some heart failure and is almost certainly due to untreated high blood pressure.

    00:41 So, the clues here: he has dyspnea, shortness of breath, he has nasty untreated hypertension, and there's sounds like there's some heart failure involved here probably from untreated hypertension.

    00:54 And here's his cardiogram.

    00:57 Take a look at it for a few minutes and see if you can identify the abnormalities.

    01:09 So, notice first of all, big tall R wave in lead 1.

    01:15 Notice deep S waves in the precordial leads V1, V2, V3 and you'll notice also abnormal ST segments and there's also increased voltage in V4 and V5.

    01:33 All of these together says left ventricular hypertrophy with ST changes.

    01:39 This suggests in fact quite severe left ventricular hypertrophy.

    01:44 The diagnosis is left ventricular hypertrophy.

    01:47 You'll notice also that the T waves are inverted in leads V5 and V6.

    01:53 Also, part of this left ventricular hypertrophy with ST and T wave changes.

    About the Lecture

    The lecture ECG Case: 52-year-old Man with Shortness of Breath by Joseph Alpert, MD is from the course Electrocardiogram (ECG) Interpretation.

    Included Quiz Questions

    1. Tall R wave in lead I, deep S waves in V1–V3, and increased R voltage in V4 and V5
    2. Tall R waves in V1, deep S waves in lateral leads, and right-axis deviation
    3. Tall peaked P waves (> 2 mm)
    4. ST elevations in leads II, III, and aVF
    5. Low voltages in leads V4, V5, and V6 with prominent R wave in V1

    Author of lecture ECG Case: 52-year-old Man with Shortness of Breath

     Joseph Alpert, MD

    Joseph Alpert, MD

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