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Electrocardiographic QRS Axis Shift With Left Anterior Hemiblock

Angelo A. Deliyannis, MD; Alexander D. Symvoulidis, MD; Dora Mayopoulou-Symvoulidis, MD
JAMA. 1971;217(3):341. doi:10.1001/jama.1971.03190030065022.
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To the Editor.—  In response to the paper of Ewy et al (215:429-432, 1971), we wish to report a case of intermittent left anterior hemiblock that seems to be related to metabolic factors other than hyperkalemia.

Report of a Case.—  A 19-year-old boy was admitted to the hospital with severe renal failure secondary to chronic glomerulonephritis. He had been receiving lanatoside C intravenously in doses of 0.4 mg every other day. On admission he was confused, oliguric (300 mg/24 hr), and was vomiting. The blood pressure was 140 mm Hg systolic and 80 mm Hg diastolic, and remained within normal limits during his hospitalization. The ocular fundi were normal. An ejection systolic murmur was heard over the base and the apex of the heart. Examination of the roentgenogram revealed the cardiac silhouette to be within normal limits.The blood urea nitrogen (BUN) level was 660 mg/100 ml; hemoglobin level,


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