RVH

Report:

Sinus rhythm 70/min

Right axis deviation + 130o

qRV1 – right ventricular hypertrophy

Comment:

Most ECGs looking like this would suggest primary pulmonary hypertension, especially in a young woman. The heart has a limited repertoire: this example of RVH is the result of the RV being the systemic ventricle, due to congenital transposition (TGA) treated – now decades ago – by Mustard operation. The latter is, functionally, an atrial rather than an arterial switch.

The P waves are unremarkable – certainly no P pulmonale of emphysema – but do have a rightward axis, certainly over +70o.

Given the marked improvement in surgical treatment of congenital malformations30, there are now as many adult survivors as children with history of corrective or palliative surgery31.

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