ECG OF THE WEEK

Prof.VIJAYARAGHAVAN‘S UNITB.Elavazhagan.

A 20 YEAR OLD MALE, A KNOWN CASE OF CHD PRESENTED TO THE opd.

ECG

ECG

SUMMARY OF THE FINDINGS Rate – 120/min Sinus rhythm Tall peaked P wave in lead 2 Predominantely positive P wave in V1 PR interval- 0.16 s, QRS Complex –0.12 s, ST ,T normal; Extreme right axis

CONTD………. QRS configuration – V1 shows RS complex; abrupt change to rS in V2; leads V3-V6 shows rS complexes aVR shows qR complex.

Lead 1 shows deep S wave

Lead 2 & 3 shows S waves

INFERENCE

Right ventricular enlargement Right atrial enlargement Right axis deviationS 1 S 2 S 3 pattern

CRITERIA FOR RVH SOKOLOW LYON CRITERIA : R V1 + S V5/V6 > 1.1 mv

BUTLER LEGGET CRITERIA : Tallest R /R’ in V1 + deepest S wave in LEAD 1 /V6 – s wave in V1 > 0.7 mv

OTHER FEATURES; -RIGHT AXIS DEVIATION ,CLOCKWISE ROTATION -RBBB PATTERN ,R: S > 1 IN V1 ,R /R ‘ > 5 mm P WAVE AXIS > 60 DEG – ACQUIRED HEART

DISEASE UPTO 60 DEG –CONGENITAL HEART

DISEASE

DIFFERENTIAL DIAGNOSIS FOR S1 S2 S3 PATTERN WITH RVH COPD –P axis > 70 ; low voltage QRS in

precordial leads

Endocardial cushion defects –QRS north west axis

LAHB deep S in lead 2 >

lead 3;

VSD with PHT –LVH with RVH right axis deviation;

Complete TGA – av block and other heart blocks ;

CONTD………. Isolated pulmonary stenosis /atresia—

RVH with S1 S2 S3 pattern but deep T

wave inversion present in addition

Triology of fallot – LAE ,widening of P wave

Tetrology of fallot – - RVH , RAE , S1 S2 S3 PATTERN , right axis deviation around 120 – 150 degrees -Rs pattern in V1 abrupt change to rS V2

and subsequent leads T inversion may be seen in V1 ,but not in

others

DIAGNOSISSince the ecg of our patient has1.RAE2.RVH3.RIGHT AXIS DEVIATION4.S1 S2 S3 PATTERN5.CLOCK WISE ROTATION THE DIAGNOSIS IS “TOF”

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