Right Atrial Abnormality

Report:

Sinus rhythm

Right atrial abnormality

Comment:

The P wave is over 2.5 mm tall . It is characteristically peaked, and its axis is over +70o; these additional criteria are not necessary for the diagnosis of RAA. The older term, P pulmonale, is still used, perhaps with greater legitimacy than its counterpart, P mitrale.

While old inferior MI is possible, the Q waves observed in the inferior leads are not diagnostically significant; further, one would expect less normal QRS/T in the rest of the trace.

T3 is taller than T1, but this is not abnormal per se in a vertical heart (aVL and aVF converging).

It is not clear why pulmonary embolism is mentioned in the report. The following trace (Case 212) reveals that a high index of suspicion was already there!

212. Same patient, repeat ECG. New report, by the same Consultant: ‘S1Q3 pattern has developed with inverted T waves in V1 & V2. Suspect PE’

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