Right atrial enlargement (RAE) involves dilatation of the right atrial cavity and hypertrophy of its muscular wall.


Changes in the ECG seen with right atrial enlargement:

(1) P wave frontal axis +65 to +90°

(2) normal duration of the P wave

(3) tall P wave > 0.25 mV (2.5 mm) in lead II with an initial deflection

(4) qR pattern in V1 in the absence of coronary artery disease

(5) decreased QRS amplitude in V1 relative to V2, with amplitude < 6 mm

(6) ratio of QRS amplitudes V2/V1 > 3


The changes in the P wave may be referred to as P pulmonale.


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