Electrocardiogram # 2


Three year old boy with Ebstein Anomaly and Pulmonary Valve Stenosis (PVS)


The ECG tells the story-Marked Right Atrial Enlargement  – Very tall (tent shaped ) P waves more marked  in leads 11,V1,V2  and  V3R ( secondary to pressure load from the PVS and volume load from venous return on the right atrium)

In most lesions with Right Atrial Enlargement we expect to see Right Ventricular Hypertrophy. With this anatomy the right ventricle is small.  The electrical activity representing this chamber is diminished.