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
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
- Right atrial enlargement: P pulmonale
- P wave amplitude > 2.5mm in leads II, III and aVF
Example 2
- Right atrial enlargement: P wave amplitude > 1.5 mm in V1 and V2
Related Topics
References
- Harrigan RA, Jones K. ABC of clinical electrocardiography. Conditions affecting the right side of the heart. BMJ. 2002 May 18;324(7347):1201-4. PMID: 12016190
- Chung DC, Nelson HM. ECG – A Pictorial Primer [internet]
LITFL Further Reading
- ECG Library Basics – Waves, Intervals, Segments and Clinical Interpretation
- ECG A to Z by diagnosis – ECG interpretation in clinical context
- ECG Exigency and Cardiovascular Curveball – ECG Clinical Cases
- 100 ECG Quiz – Self-assessment tool for examination practice
- ECG Reference SITES and BOOKS – the best of the rest
Advanced Reading
- Brady WJ, Truwit JD. Critical Decisions in Emergency and Acute Care Electrocardiography
- Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric
- Wagner GS. Marriott’s Practical Electrocardiography 12e
- Chan TC. ECG in Emergency Medicine and Acute Care
- Rawshani A. Clinical ECG Interpretation
- Mattu A. ECG’s for the Emergency Physician
- Hampton JR. The ECG In Practice, 6e
ECG LIBRARY
Electrocardiogram
Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |