RVH: Chronic Cor Pulmonale in COAD
Report:
Sinus rhythm 93/min
Right axis deviation +110o
Right atrial abnormality
P axis + 80o
Right ventricular hypertrophy
Comment:
The entire trace is, in fact, in favour of RVH: the RAD and the RAA as much as the qR morphology of V1 and the precordial T wave inversion stopping short of V6. Inferior T wave inversion is also consistent with RVH.
The little q wave in V1 is said to represent right atrial enlargement in this setting72.
The patient had very impressive pulmonary hypertension on Swan-Ganz catheter: 70/30 mmHg, but her hypoxæmia and hypercarbia precluded the diagnosis of primary pulmonary hypertension – as did her overinflated wheezy lungs.
She recovered as mysteriously as she decompensated and was discharged home after 17 days in hospital. L'homme propose, Dieu dispose. At the time of this writing, 10 years later, I suppose (no rhyme intended) God had disposed of her. But in ICU, as in life, even a little time is precious: who can tell what she and her family made of it?
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