Here is an X -Ray and ECG of a patient who came with palpitation , which he said descriptively
“I could feel it with my hands over chest “
He also had class 3 dyspnea and nocturnal chest pain . (Read here : What is the mechanism of nocturnal angina in AR ? )
Clinically it was classical severe aortic regurgitation .
His x – ray and ECG showed
- q represents LV end diastole . The maximum diastolic stress point.
- q indicate septal forces . When LV is dilated q also reflect cavity potential . Both gets summed up inscribing a classical deep q
- In severe volume overload LV is not only dilated , it’s mass increases and is brought near the chest wall . Since the leas V 5 and V6 are the most proximal to LV both R and q increase correspondingly (Shall we call as reversed Brody effect ? )
Other findings of volume overload of LV are
While deep q is very valuable in LV diastolic volume over load there are other useful ECG signs.
- Increased qrs amplitude (May be equally important like deep q . Both always go together )
- Absence of typical ST/T changes (Systole is stress free !in pure AR/MR) . Still , ST/T changes can occur if there is associated LV dysfunction.
- Left axis deviation.
- Left atrial enlargement (In case of MR/ Large L-R shunts / or late stages of AR )
- Rarely U waves are reported in LV volume overload*
Can we dignose volume overload without q waves in V 5 , V 6 ?
Most times no, but if there is associated incomplete LBBB q wave disappears.
Which is rare in pure volume over-load. In fact absence of q in isolated systolic overload of LV is attributed to the presence of incomplete LBBB by the ECG legend Shamroth !