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

• The P Wave
• Left Atrial Enlargement
• Biatrial Enlargement

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
• Chung DC, Nelson HM. ECG – A Pictorial Primer [internet]
  

Advanced Reading

Online

• Wiesbauer F, Kühn P. ECG Mastery: Yellow Belt online course – Become an ECG expert. Medmastery
• Wiesbauer F, Kühn P. ECG Blue Belt online course: Learn to diagnose any rhythm problem. Medmastery
• Rawshani A. Clinical ECG Interpretation ECG Waves
• Smith SW. Dr Smith’s ECG blog.

Textbooks

• Mattu A, Tabas JA, Brady WJ. Electrocardiography in Emergency, Acute, and Critical Care. 2e, 2019
• Brady WJ, Lipinski MJ et al. Electrocardiogram in Clinical Medicine. 1e, 2020
• Straus DG, Schocken DD. Marriott’s Practical Electrocardiography 13e, 2021
• Hampton J. The ECG Made Practical 7e, 2019
• Grauer K. ECG Pocket Brain (Expanded) 6e, 2014
• Brady WJ, Truwit JD. Critical Decisions in Emergency and Acute Care Electrocardiography 1e, 2009
• Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric 6e, 2008
• Mattu A, Brady W. ECG’s for the Emergency Physician Part I 1e, 2003 and Part II
• Chan TC. ECG in Emergency Medicine and Acute Care 1e, 2004
• Smith SW. The ECG in Acute MI. 2002 [PDF]

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