Cor Pulmonale: RVH with RBBB
Pre-Transplant Fibrosing Alveolitis
Report:
Sinus rhythm.
Borderline first degree AV block (PR 0.20").
Right atrial abnormality ? biatrial enlargement.
Right axis deviation
Right bundle branch block.
Right ventricular hypertrophy
Comment:
The tendency of RVH to express itself as right axis deviation makes the ECG diagnosis of LPHB virtually impossible: RVH has to be excluded clinically. The exception to this rule is a transient hemiblock which obviously cannot be the due to RVH.
The QR morphology in V1 also supports the diagnosis of RVH; the Q wave is most likely due to right atrial enlargement154 rather than a septal infarct.
The P wave in lead 1 is 3 mm tall but does not have the expected rightward shift to over +70o; the PTF is greater than 1 x 1 mm in V1. This may represent a biatrial enlargement. P wave in V2 has the expected V1 morphology of right atrial enlargement.
Echocardiogram showed only right-sided dilatation and RVH; the LV and LA were in fact normal. It is significant that the LV leads V5-6 have normal repolarisation.
ECG taken before the onset of the RBBB is shown below (Fig 218a), with diagnostic narrow qR in V1 and more obliging P pulmonale.
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