Chronic thromboembolic pulmonary hypertension (CTEPH)

A 51-years old male came with a history of dyspnoea on exertion for the last 6 months. The patient was a known case of deep venous thrombosis of the right lower limb and was on irregular treatment. Echocardiography showed grossly dilated right atrium and right ventricle with normal left ventricular ejection fraction. Severe tricuspid regurgitation was present. Estimated RVSP: 110 mmHg. ECG of the patient is shown below.

Source of the ECG: VMMC & Safdarjung  Hospital, Ansari Nagar, Delhi

ECG is showing normal sinus rhythm @90 bpm, axis 90 degrees, right axis deviation, PR 160 msec, P pulmonale is present, (P wave amplitude in lead II is more than 2.5 mm), prominent R wave in lead V1-V3 with deep symmetrical T wave inversion with  ST-segment depression seen, R wave in lead V1 8 mm,  R wave in lead V1 is 8 mm, RS ratio in lead V1>1, Prominent S wave in lead V5, ST-segment depression with T wave inversion also seen in lead V5, V6. 

Diagnosis of the ECG: Right ventricle hypertrophy with right ventricle strain pattern with right atrial enlargement.

The patient was diagnosed as a case of Chronic thromboembolic pulmonary hypertension (CTEPH) and was referred to the CTVS department for endarterectomy. 

Thank You

Dr. Praveen Gupta