Electrocardiographic changes in Atrial Septal Defect.

Fig. 3: ECG at 50 mm/sec speed showing the notch in R waves in lead 2 A 3 0 y e a r o l d m a n p r e s e n t e d with orthopnoea, palpi tat ion and exerc ise intolerance . He had had recurrent respiratory infections since childhood. However, due to res idence in a remote vi l lage, he had never visited any hospital for these problems. On examination he was found to have raised pulsatile jugular veins and mild cyanosis. Blood pressure was 100/60 mm of Hg. Cardiac echocardiography revealed ostium primum (OP) atrial septal defect (ASD) and atrio-ventricular septal defect with moderate mitral regurgitation and severe tricuspid regurgitation (TR) (TR gradient: 76 mm of Hg) (Figure 1). There was right ventricular and right atrial hypertrophy. Electrocardiography (ECG) showed (Figure 2):