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This ECG was recorded from a 17-year-old girl who was breathless, had marked ankle swelling with signs of right heart failure, and who had been known to have a heart murmur since birth. She was acyanotic. What ECG abnormalities can you identify and can you suggest a diagnosis?
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- Sinus rhythm
- Markedly peaked P waves (best seen in leads II, Vi)
- Normal axis
- Dominant R wave in lead Vl
The ECG shows right atrial and right ventricular hypertrophy.
Right atrial hypertrophy is seen with pulmonary hypertension of any cause, tricuspid stenosis, and Ebstein’s anomaly. Right ventricular hypertrophy is seen with pulmonary stenosis and pulmonary hypertension. These conditions can all be diagnosed by echocardiography. This patient had Ebstein’s anomaly and an atrial septal defect.
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