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.