Can His Heart Handle a Hip Operation?

ANSWER

The ECG shows evidence of sinus rhythm, left ventricular hypertrophy, and a prolonged QT interval. Although it may be tempting to label the RR’ in lead V₁ as right bundle branch block, recall that bundle branch block occurs with a QRS duration > 120 ms, which is not present here.

Left ventricular hypertrophy is demonstrated by high voltages in the precordial leads (S in lead V₁ and R in lead V₅ or V₆ ≥ 35 mm); compare this with the ECG in the May issue of Clinician Reviews (2017;27(5):9, 13). A prolonged QT interval is suggested by a QTc interval of 500 ms.

The patient’s family history of sudden cardiac death makes these findings particularly concerning; genetic workup should be considered for both the patient and his children.