P Congenitale

Report:

Sinus rhythm

First degree AV block

PR 0.22”

Right atrial abnormality

P height 5 mm in lead 2

P wave height > 1.5 mm in V1

P congenitale

P1 > P3 & P > 2.5 mm in a limb lead

Right axis deviation +230o

Probable right ventricular hypertrophy

Possible left ventricular hypertrophy

Comment:

The patient had, of course, biventricular hypertrophy; the ‘probable’ and the ‘possible’ above represent the constraints of electrocardiographic reporting. He had both an ASD and a VSD.

The P wave axis is only +40o due to large P in lead 1 and smaller one in lead 3. This is the pattern of P congenitale. Congenital heart disease productive of both right atrial hypertension and hypoxæmia produces the tallest P waves in cardiology. Mere distension from volume overload – e.g., in ASD – rarely produces very large P waves.

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