Left Atrial Enlargement

Lead II

        P wave biphasic

        Terminal negative component at least 0.04 second in duration and 1 mm deep (i.e., I mall square x 1 small square x 1 small square)

        P axis to left (-30⁰ or less)

Right Atrial Enlargement

Lead II

                  P peaked ( “P” pulmonale”) Greater than 2.5 mm height but duration normal.

          Lead V₁

                  Biphasic

                  Initial component 2.5 mm or greater or terminal component as in left atrial enlargement

                  May be entirely negative

                  P axis to right (+75⁰ or more)

Right Atrial Enlargement occurs in

            (1) Ebstein’s anomaly

            (2) Cor pulmonale

            (3) Tricuspid stenosis

            (4) Pulmonary hypertension

Combined Atrial Enlargement

       Lead II

             P duration and amplitude both increased.

         A dominant negative QRS complex in L1 suggests right axis deviation where as a dominant negative complex in aVF suggests left axis deviation. A tall RV1, greater than 5 mm or R/S in VI greater than 1 with ST depression and T inversion suggests right ventricular hypertrophy.

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