ECG Case 041

This is an ECG example of dilated cardiomyopathy demonstrating signs of enlargement of all four cardiac chambers:

• There is marked LVH with very deep S waves in V2-4.
• Right axis deviation suggests associated RV enlargement (= biventricular enlargement).
• Evidence of left atrial enlargement (deep, wide terminal portion of the P wave in V1).
• Peaked P waves in lead II suggestive of right atrial enlargement (~ 2.5mm in height).

This patient had four-chamber dilatation on echocardiography with severe congestive cardiac failure (awaiting cardiac transplantation).