Pædiatric Right Ventricular Hypertrophy

Report:

Probable flutter 300/min with 2:1 block

Right axis deviation

Right ventricular hypertrophy

Comment:

In children with congenital heart disease the abnormal RAD is usually manifest as S1S2S3 morphology. The qR in V1 indicates that it is a true RAD, due to RVH.

In L2 there is a what looks like a rather squat, rounded secondary R wave. It is almost certainly a second F wave, falling exactly in-between the easily seen atrial deflections. The proof, as often happens, is in a repeat trace, with variable block (Fig 56a below).

The next two tracings (Figs 56b, 56c) show junctional and sinus rhythms, post-cardioversion. The former has retrograde conduction.

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