Electrocardiogram in a young child with pulmonary hypertension

ECG obtained in a 3 year-old child with pulmonary hypertension. Findings include:

Right atrial enlargement (arrow): The P wave in lead II is >2.5 mm. This is sometimes referred to as "P pulmonale."
Right ventricular hypertrophy: Tall R waves in V1 and deep S waves in V5 and V6 suggest RVH. R wave amplitude in V1 is 30 mm (upper limit of normal for this age is 20 mm).
Rightward axis deviation: QRS axis in this child is 125 (upper limit of normal for this age is 110).

ECG: electrocardiogram; RVH: right ventricular hypertrophy.

Graphic 114962 Version 6.0

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