Click on the image for a larger view
ECG showing gross left ventricular hypertrophy (LVH) with strain in case with severe aortic stenosis. The R waves in V5 and V6 are so tall that they are overlapping with the tracing in the channel above. ST segment depression and T wave inversion are seen in inferior and lateral leads. This is a pressure overload pattern which can be seen also in severe systemic hypertension and hypertrophic obstructive cardiomyopathy. In hypertrophic obstructive cardiomyopathy there may be associated prominent Q waves due to septal hypertrophy. In volume overload pattern the ST segment depression and T wave inversion are not usually seen while the R waves will be tall in lateral leads and the T waves upright and tall. A small narrow q wave is also seen in in volume overload patterns due to aortic regurgitation or patent ductus arteriousus / ventricular septal defect with large left to right shunt. LVH with strain pattern can sometimes be seen in long standing severe aortic regurgitation, usually with associated left ventricular hypertrophy and systolic dysfunction.