RVH in Eisenmenger’s Syndrome

Report:

Sinus rhythm

Second degree AV block, Möbitz 1

Junctional escape beats

Biatrial enlargement [!xe "Biatrial enlargement" \b!]

Right axis deviation

Right bundle branch block[!xe "Right bundle branch block:qRV1 in RVH" \b!]

Probable right ventricular hypertrophy[!xe "Right ventricular hypertrophy:single ventricle Eisenmenger" \b!]

Comment:

This is one of the variants associated with a common ventricle; the commonest one, however, has predominantly negative rS complexes across the precordium. The pattern recorded here is associated with concomitant transposition of the great vessels188 and is obviously complicated by the presence of RBBB.[!xe "Single (common) ventricle:RVH pattern" \b!][!xe "Cor triloculare biatrium" \t "See Single ventricle" \b!]

The right axis deviation cannot be ascribed, electrocardiographically, to a left posterior hemiblock unless there is a clinical exclusion of right ventricular hypertrophy.

The initial q wave in the qR complex in V1 may be due to right atrial enlargement189.

An episode of AV dissociation is shown below (Fig 257a). It resembles, at first glance, escape-capture bigeminy, but there is no bigeminy: just regular junctional rhythm. The allorhythmia in Fig 257 above could, on the other hand, be described as escape-capture trigeminy.