Diagnostic criteria

  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).




Among congenital heart diseases, EXAGGERATED right atrial abnormality is seen in

  Ebstein's anomaly

  Total anomalous pulmonary venous return

  Severe pulmonary stenosis

  Tricuspid atresia



Although NOT EXAGGERATED atrial septal defect (ASD) may also show right atrial abnormality.




About the definition

  Previously P pulmonale , P congenitale , right atrial dilatation , right atrial hypertrophy ,

      atrial overload
were used.

  However, the above mentioned ECG findings can be observed not only in patients with atrial

      muscular hypertrophy but also in patients with increases in atrial pressure, ventricular diastolic

      dysfunction or intaatrial conduction disturbances.

  Therefore it is suggested that use of the term
right atrial abnormality will reflect these changes better.



References

  Circulation 2009,119:e251-e261.

  American Journal of Emergency Medicine 2008;26:221-228.





ECG 1. The
tall and pointed P waves show right atrial abnormality.

Click here for a more detailed ECG





ECG 2.
Right atrial abnormality is seen in a patient with chronic obstructive pulmonary disease (COPD).

Click here for a more detailed ECG





ECG 3. The ECG above belongs to a 6 years old child. Because of critical pulmonary stenosis in the neonatal period, he had
undergone first pulmonary balloon valvuloplasty and then pulmonary valvulotomy. Recently, the echocardiography revealed
severe tricuspid regurgitation and moderate pulmonary regurgitation.
Right atrial abnormality is so obvious that the amplitude
of the P wave in lead II
is above than that of the following QRS complex. In severe pulmonary stenosis, also a higher than
expected R wave amplitude in lead C1
is usually observed.

Pediatric Cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

Click here for a more detailed ECG





ECG 4. The ECG above belongs to a 9 years-old boy who had been operated for severe pulmonary valve stenosis in the past.
His recent echocardiography showed a dilated right atrium.
Fourth degree (severe) tricuspid regurgitation and third degree pulmonary regurgitation was observed by Doppler ECHO.

The P waves in lead II
are so large that they have the same amplitude with the same amplitude with the following QRS complexes .

Pediatric Cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

Click here for a more detailed ECG