A 15 years old male came with complaints of dyspnoea on exertion since 3 month of age along with cyanosis and clubbing of bilateral upper and lower limb fingers. On pulse oximetry oxygen saturation was 80%. On cardiovascular examination,, ejection systolic murmur was present in the 2 left intercostal space. with single S2(A2), ecg of the patient is shown below.
ECG
ECG is showing heart rate around 75 beats per minutes, there is right axis deviation with axis being 120 degrees, there is tall R wave or qR wave seen in lead V1 suggestive of right ventricular hypertrophy, peaked P wave seen but they were not fulfilling the criteria for right atrial abnormality, there is rapid transition of QRS complex from lead V1 to lead V2.
Patient echo done which was suggestive of right ventricular hypertrophy along with large subaortic ventricular septal defect with right to left shunt with overriding of aorta suggestive of tetralogy of fallot.
Let's discuss ECG in tetralogy of fallot (TOF)
Characteristic feature in ecg in a patient with TOF is
Peaked P wave, narrow duration
Right axis deviation
Right ventricular hypertrophy but no evidence of right ventricular strain pattern
Sudden QRS transition from lead V1 to lead V2
rS complex in lead V5,V6 when there is reduced pulmonary blood flow with decreases left ventricle fillin
Q wave with dominant well developed R wave in lead V5,V6 in patient with mild pulmonary stenosis with balanced shunt indicating good LV filling
Reference -Perloff pediatric cardiology 6th edition, chapter 18, Page 385
Thank you.
Praveen Gupta
Praveen Gupta
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