A 60 year old marathon runner complains of dizziness episodes. On auscultation ejection systolic murmur is heard. ECG is done. Clinical diagnosis is?: (A) HTN with Atrial fibrillation, (B) LVH with Valvular Aoic stenosis, (C) RVH with Valvular Pulmonic stenosis, (D) Brugada Syndrome
Answer is B. The ECG shows hea rate of 50/min with left axis. Patient is in normal sinus rhythm. QRS duration is normal. T wave inversion is noted in lead I, aVL and V5-V6 indicating possible ischemic changes. Depth of S wave in V1 =20mm Height of R wave in V5= 30mm SV1 + RV5/6(tallest R in either V5 or V6) >35 mm is diagnostic of Left ventricular hyperophy( Sokolov- Lyon criteria) The low hea rate is explained by high vagal tone seen in marathon runners.