The EKG findings include right axis deviation, tall R waves in V1 and V2 with R>s in these leads, Twave inversion across the precordium but most marked in V1-V3 with ST segment depression and a “strain T” morphology (slow down, fast up, non-symmetric), and very pointy, tall P waves in the inferior leads and in V1.
Taken together, this constellation of findings strongly suggests RVH with “strain” (pressure and/or volume overload) with right atrial enlargement (the pointy P waves in the inferior leads, 3 boxes tall. Right atrial enlargement gives TALL P waves in the inferior leads (“P pulmonale”), whereas left atrial enlargement gives wide, “M” shaped P waves (“P mitrale”). In a young woman, the most likely cause is congenital heart disease.
NOTE: EKG's are for internal educational purposes of the University of Massachusetts Department of Family Medicine. Please do not forward without permission from Dr. Golding!
