Left ventricular hypertrophy with strain pattern and giant T wave inversion

ECG Quiz 15

There is evidence of gross left ventricular hypertrophy with strain pattern. Tall R waves with ST segment depression and T wave inversion are seen in leads I, aVl and V4 – V6. The T wave inversion is asymmetric, unlike that in ischemia. The T wave inversions in lateral leads are deep, with maximum of 17 mm depth in lead V3. Such gross left ventricular hypertrophy with strain pattern is typical of hypertrophic obstructive cardiomyopathy. Severe long standing hypertension and severe aortic stenosis are other conditions in which similar pattern can be seen. Giant T wave inversions without features of hypertrophy can be seen soon after a cardiac arrest. But the T waves will be wide and the QT interval will be prolonged in those cases. Giant T wave inversions can also be seen in cerebrovascular accidents.