RVH in COAD

Report:

Atrial fibrillation, mean ventricular rate 85/min

Right axis deviation + 130o

qRV1, probable right ventricular hypertrophy

Nonspecific ST/T changes

Comment:

RVH is seldom expressed as dominant R wave in V1 in COAD; the commonest change is RAD in combination with persistent S waves in left precordial leads. The initial q wave in the qR complex seen here probably denotes right atrial enlargement92 (and is thus its only sign when P waves are absent).

The general sensitivity of ECG is low for RVH in COAD, less than 1/3 being clinically recognised. On the other hand, fully expressed RVH like this one is quite specific, and pulmonary hypertension can be safely predicted. This patient could be excluded from volume-reduction surgery on the basis of her ECG alone.

The QRS complex is characteristically thin in emphysema (0.07” here), although lower limit of normal QRS duration has not been defined in terms of any specific pathology.

The ventricular rate is controlled by drugs (digoxin and verapamil). There is a suggestion of sinus P waves in some cycles, but this is an illusion, recognised if one examines those phantom Ps in simultaneous channels.

An echocardiogram showed normal left and dilated right-sided chambers.

An ECG taken 5 years later is shown in Fig 124a below. She did rather well, considering.