Wednesday, April 28, 2010

21 yo F with Syncope has Right Ventricular Hypertrophy and Pulmonary Hypertension

This 21 yo otherwise healthy woman, with a history of one episode of syncope 3 months prior, had onset of SOB, chest tightness, and epigastric pain, then was syncopal. Medics found her ashen and cyanotic and could not obtain a BP. On arrival in the ED, the patient denied CP and SOB, and had a BP in the 90's.

She had the ECG above recorded.

There are large R-waves in the right precordium (V1-V3) and a deep S-wave in lead I. This is diagnostic of right ventricular hypertrophy.

She was admitted to the hospital and found on echo and right sided catheterization to have significant right ventricular hypertrophy, pulmonary hypertension with pulm art pressures of 80/26, and a patent foramen ovale with some right to left shunting.

The likely diagnosis is primary pulmonary hypertension.

She had been seen in an emergency department after the first syncopal event, but this was apparently missed.


  1. Should one consider the P-waves in leads II and III indicative of p pulmonale? They appear to be over 2.5 mm and, perhaps in lead II, peaked.

  2. Her QT looks prolonged to me. DO you know what the QTc is?

  3. Good observation. Computerized QTc is 487. I believe that prolonged QTc is typical in hypertrophies, but don't have any literature to prove it.

  4. Good point about the P waves in leads II and III. There is a peaked P (P pulmonale) in lead II.

  5. What's the reason for St depression from V2 to V6

    1. Repolarization abnormalities secondary to abnormal depolarization of right ventricular hypertrophy


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