S1S2S3 Pattern
Report:
Sinus rhythm
Borderline biatrial abnormality
Indeterminate axis 200o
S1S2S3 pattern
RSR’ V1
Comment:
The diagnosis of S1S2S3 pattern requires, strictly speaking, S wave larger than the corresponding R wave in the three standard leads, as in this trace. It is often seen in healthy individuals but, combined, as, again, in this trace, with RSR’ in V1 and prominent secondary R wave in that lead, it may be indistinguishable from RVH. The decision has to be made on other grounds.
As in emphysema with LAD, the S2 is deeper than S3, distinguishing it from LAHB, the commonest cause of LAD in adults.
The P waves are peaked but do not reach the 2.5 mm height required for the RAA; the PTF in V1 just makes 0.04”. Further curious feature is the notching of the R wave in leads 3 and aVF; it could pass for crochetage now recognised as a marker of ASD114. Some even find it a marker of patent foramen ovale (PFO) in ischæmic CVA115.
With all that, the patient’s only diagnoses were the psychiatric ones.
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