Question:
37 yo F with diastolic murmur @ RUSB and this CXR presents with which ECG (top vs bottom) and why❓
Chest X-ray
ECG (top and bottom)
Answer
- Which ECG: Top (Pink)
- Why? Top ECG is the one that shows LVH with diastolic overload pattern
Learning points:
This CXR shows ascending aortic enlargement and LV enlargement. The diastolic murmur at the RUSB suggests aortic regurgitation (AR) due to aortic root enlargement. Chronic AR leads to LV volume overload on CXR and LVH with diastolic overload pattern on EKG (increased QRS voltage and asymmetrically-peaked upright T waves). This is contrasted by the findings with aortic stenosis (AS) where the EKG shows LVH with T wave inversion laterally (like EKG B) and on CXR the LV would not be enlarged until heart failure ensues.
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