January/2008

ANSWER 10=B

DISCUSSION: The rhythm is sinus rhythm. Although some T waves may be confused with P waves, the T wave in lead II is distinctly different in morphology to the P wave in that lead. There is an abnormal R wave progression. The term “R wave progression” is used to denote the height of the R wave from V1 to V6. The R wave in V1 can be normal. But then the R wave in V2 is very tall and then in V3 it is smaller – of lesser amplitude – than the R wave in V2. This is obviously abnormal. There are no signs of an anterolateral myocardial infarction. In the latter, the patient would have had Q waves or QRS and ST changes in leads I and aVL in the limb leads. There are signs of right atrial enlargement. This fits the clinical picture of a an acute pulmonary problem on chronic lung disease.