Right venrticular hypertrophy due to Ostium secundum or sinus venous atrial septal defect

ECG shows sinus rhythm with heart rate approximately 90, min with p axis , amplitude and duration being normal. The PR interval and QT interval are normal. There is a slight slurring of the QRS complex {rR’} but the QRS duration is normal .The QRS vector could be plotted to 150°. aVR shows predominant R wave which could signify severe RVH. The right ward QRS voltage are abnormal, manifested by deep S in lead I and V6 {10- 12 mm } and tall R waves in and V1 {15 mm } all beyond ULN suggestive of right ventriculr hypertrophy {RVH}. The R, S ratios in V1 ,V2 , and V6 are all abnormal, suggesting RVH. T axis is normal.
Impression- Severe RVH .
In view of age and repeated respiratory tract infections and abnormal second heart sound the possibility of Ostium secundum or sinus venous atrial septal defect should be kept in mind. {Ostium primum would have presented with superior axis}

E-published: May 2007 Vol 4 Issue 5, Art # 19