An 84 year old lady with hypertension.

Left anterior hemiblock, LVH, LAH, and long PR

There are a number of abnormalities here.

• left anterior hemiblock
  • QRS axis more left than -30 degrees
  • initial R wave in the inferior leads (II, III and aVF)
  • absence of any other cause of left axis deviation
• left ventricular hypertrophy
  • In the presence of left anterior hemiblock the diagnostic criteria of LVH are changed. Rosenbaum suggested that an S wave in lead III deeper than 15 mm as predictive of LVH.
• long PR interval (also called first degree heart block)
  • PR interval longer than 0.2 seconds
• left atrial hypertrophy
  • M shaped P wave in lead II
  • P wave duration > 0.11 seconds
  • terminal negative component to the P wave in lead V1