Right Atrial Enlargement

ECG Criteria of Right Atrial Enlargement

Right atrial enlargement produces a peaked P wave (P pulmonale) with amplitude:

  • > 2.5 mm in the inferior leads (II, III and AVF)
  • > 1.5 mm in V1 and V2

Also known as: Right Atrial Enlargement (RAE), Right atrial hypertrophy (RAH), right atrial abnormality

P wave changes with Right Atrial Enlargement
P wave morphology RAE Wagner 2007

Causes of Right Atrial Enlargement

The principal cause is pulmonary hypertension due to:

  • Chronic lung disease (cor pulmonale)
  • Tricuspid stenosis
  • Congenital heart disease (pulmonary stenosis, Tetralogy of Fallot)
  • Primary pulmonary hypertension

ECG Examples

Example 1
ECG Peaked P waves (P pulmonale) RAH
  • Right atrial enlargement: P pulmonale
  • P wave amplitude > 2.5mm in leads II, III and aVF

Example 2
P pulmonale Right atrial hypertrophy in V1 V2
  • Right atrial enlargement: P wave amplitude > 1.5 mm in V1 and V2

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Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

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