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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