Right Ventricular Hypertrophy: Scleroderma
Report:
Sinus rhythm
Probable RAA
Right axis deviation + 130o
qRV1
Right ventricular hypertrophy
Comment:
The qR morphology of V1 is, by itself, evidence for right atrial enlargement as well as RVH; the prominent monophasic P in V2 supports it and increased PTF in V1 is consistent with it, too. There may also be some LAA (the commonest cause of increased PTF) but this patient has no reason for it clinically. She most likely has clinically silent pulmonary hypertension secondary to the connective tissue disease. Scleroderma cardiac disease is often secondary to renal or pulmonary involvement, but myocardial lesions are not exactly rare116.
The RAD is, electrocardiographically, very strong evidence for RVH; it helps differentiate RVH from anteroseptal infarction117.
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