Atrial Septal Defect
Report:
Sinus rhythm 94/min
RSR’ in V1
Right precordial ST segment depression
Comment:
Over 90% of ASDs have an RSR’ pattern in V1; in time, this tends to became a proper RBBB. This is not of great diagnostic value, except when absent, in an ASD suspect. Of greater specificity is the crochetage39 in the inferior leads – in this case, 3 and (rather feebly) aVF (cf. Case 78).
The ST depression in V1-3 is very likely right ventricular in origin, but there is no other sign of RVH (no RAD, no RAA). This may be because the RV was markedly dilated from it volume overload, but not that much hypertrophied. The dilatation may also explain why the RV6 is greater than RV5 – the LV is pushed leftwards.
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