Primary pulmonary hypertension

  is a very rare disease.

  does not have any diagnostic ECG abnormality.

  ECG generally shows signs of right ventricular and/or right atrial dilation.

  About
13% of the patients have normal ECG.



ECG criteria for the diagnosis of right ventricular hypertrophy

  Right axis deviation +90 degrees or more.

  Right atrial abnormality

  R in C1 >0.7mV (>7mm).

  QR in C1.

  R/S ratio in C5 or C6 is <1 .

  R/S ratio in C1 is >1 with R >0.5mV (>5mm).

  S in C5 or C6 is >0.7mV (>7mm).

  S1S2S3 pattern.

  S1Q3 pattern.

  R in C5 or C6 is >0.4mV with S in C1 >0.2mV.




Diagnostic criteria for right atrial abnormality

  Amplitude (height) of the P wave in lead 2 is > 2.5mm (0.25mV).

      ( > 3mm is abnormal in infants up to 6 months of age )

      P wave is pointed with a single crest.

  Additional criteria:

            - Amplitude (height) of the first half of P wave in lead C1 or lead C2 is > 1.5 mm (0.15mV).

            - Rightward shift of the P wave vector.

  The P wave time (width) is generally normal (<120ms).




References

  Circ J 2012;76:1744-1749.

  Chest 2002;122:524-527.





ECG 1. Above ECG belongs to a 45 years-old man with primary pulmonary hypertension.
ECHOcardiography showed right atrial and right ventricular dilation. The right ventricle was severely hypokinetic.

Click here for a more detailed ECG