Electrocardiogram # 5


Eleven year old girl with severe Pulmonary Valve Stenosis (PVS) and cardiac failure


Right Ventricular Hypertrophy (Right Axis deviation, Deep S in V6) with strain pattern (inverted T V6)

Bi- Atrial Enlargement- Tall wide P waves in leads 11 and AVF

Left Atrial Enlargement – P Mitrale (Wide “M” shape P wave in lead V4) and wide biphasic P wave in V1

When there is significant sustained pressure on the right ventricle, this will eventually cause a strain on the right ventricle (reflected electrocardiographically as inverted T waves in the precordial leads). The right ventricle will eventually fail and as in this case the patient may develop clinical signs of cardiac failure. Typically in the paediatric population failure of one ventricle leads to failure of the other. Hence LAE here is associated with left heart failure.