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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