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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