Knee Pain, Heart Strain?

ANSWER

The correct interpretation includes normal sinus rhythm with left ventricular hypertrophy (LVH) and possible left atrial enlargement. Criteria for LVH include high voltages in the limb leads (R wave in lead I and S wave in lead III ≥ 25 mm) or the precordial leads (S wave in V₁ and R wave in V₆ ≥ 35 mm). Left atrial enlargement and ST-T wave abnormalities are often seen with LVH. The notched P wave in lead II and biphasic P wave in V₁ raise suspicion for left atrial involvement. Finally, repolarization of a hypertrophic left ventricle following systole is responsible for the tall T waves seen in leads V₂ to V₆.