Endocardial Cushion Defect & Biventricular Hypertrophy
Report:
Sinus rhythm 63/min
First degree AV block
PR 0.22”
Right atrial abnormality
Left anterior hemiblock
LAD –65o
RSR’ in V1
Biventricular hypertrophy
Katz-Wachtel phenomenon: QRS 67 mm in V4
Nonspecific ST/T changes
Comment:
The interesting feature is the left axis deviation, morphologically indistinguishable from LAHB. The mechanism of the LAD is somewhat different: the His bundle is displaced inferiorly and the anterior superior fascicle of the left bundle branch is relatively hypoplastic34.
The RAA is visible in lead 2 (P wave > 2.5 mm) but more prominent in V1, where the initial positive deflection exceeds 2 mm. It supports RVH part of the biventricular hypertrophy, still detectable in V1, with its rsR’ and upright T wave.
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