Crochetage in ASD
Report:
Sinus rhythm
Borderline left atrial abnormality
Borderline right axis deviation +90o
Incomplete right bundle branch block
Crochetage in inferior leads suggests ASD
Comment:
This one did have a fixed split of P2. She was, however, first diagnosed on this ECG.
Crochetage (just notching, but described by the French67) is said to be better than incomplete RBBB as marker of ASDs; if present in all three inferior leads, it has very high predictive power (and greater snob value). A transœsophageal echocardiogram (TOE, TEE in the USA) showed dilated right-sided chambers and pulmonary hypertension; there was a 2.8 cm defect in the atrial septum.
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