Right Atrial Abnormality
Report:
Sinus tachycardia 130/min
Right atrial abnormality
5 mm P wave in Lead 2
P wave axis + 90o
Vertical heart position
Comment:
The inferior ST segment depression (using T-P baseline) may be due, at least in part, to prominent Ta waves, inferred from 5 mm tall P waves.
The QRS complex is characteristically narrow in emphysema.
P wave axis seldom exceeds +90o; RAA is a rare cause of negative P in Lead 1. This patient’s P wave is invisible in Lead 1, completely isoelectric; the axis is therefore +90o.
Below (Fig 135a) is another cor pulmonale, in a 42 year old woman with fibrosing alveolitis. Her P wave in V1 shows prominent P-terminal force, but in V2 it is entirely positive and by V3 2 mm tall and pointed. This indicates, in the context, increased PTF due to right atrial enlargement.
Precordial T wave inversion is also in keeping with RVH. ST segment elevation in V1 can also occur in RV "strain", presumably present here with fibrosing alveolitis complicated by pulmonary infection.
The qR or qRs pattern in V1 is, in the absence of previous septal infarction, quite specific (but insensitive) marker of RVH or, more specifically, right atrial enlargement.
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