Differential Diagnosis for Deep S Waves in V1 to V4
Single Most Likely Diagnosis
- Left Ventricular Hypertrophy (LVH): Deep S waves in leads V1 to V4 can be indicative of left ventricular hypertrophy, a condition where the muscle wall of the left ventricle becomes thickened. This thickening can lead to changes in the electrical activity of the heart, resulting in deep S waves on an electrocardiogram (ECG).
Other Likely Diagnoses
- Left Bundle Branch Block (LBBB): LBBB can cause changes in the QRS complex, including deep S waves in leads V1 to V4, due to the altered path of electrical conduction through the left bundle branch.
- Ventricular Septal Defect: This congenital heart defect can lead to increased flow and pressure in the left ventricle, potentially causing hypertrophy and resulting in deep S waves on an ECG.
- Hypertension: Uncontrolled high blood pressure can lead to left ventricular hypertrophy, which in turn can cause deep S waves in leads V1 to V4.
Do Not Miss Diagnoses
- Pulmonary Embolism: Although less common, a large pulmonary embolism can cause right ventricular strain, leading to deep S waves in leads V1 to V4. Missing this diagnosis can be fatal.
- Cardiac Sarcoidosis: This condition can cause infiltration of the heart muscle, leading to conduction abnormalities and potentially deep S waves on an ECG. It is crucial not to miss this diagnosis due to its potential for serious complications.
Rare Diagnoses
- Cardiac Amyloidosis: A rare condition where amyloid proteins deposit in the heart muscle, potentially leading to hypertrophy and deep S waves on an ECG.
- Fabry Disease: A genetic disorder that can lead to hypertrophic cardiomyopathy, potentially causing deep S waves in leads V1 to V4 due to left ventricular hypertrophy.
- Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): Although primarily affecting the right ventricle, advanced cases of ARVC can lead to biventricular involvement, potentially resulting in deep S waves in leads V1 to V4.