ECG Case: 44-year-old Woman with Shortness of Breath and Fatigue

00:01 Here's a 44-year-old woman, visits her doctor, and she's complaining of increasing shortness of breath and fatigue over the last year.

00:08 She was well before that, never had rheumatic fever that she knew about, and her physical exam reveals a loud pulmonic component of her second heart sound as well as swelling of her lower legs.

00:21 So the normal second heart sound is, lub-dudub, lub-dudub, lub-dudub, but you know if you hear the second component very loud, particularly at the apex, lub-dudub, lub-dudub, lub-dudub, lub-dudub, that suggests increased pressure in the pulmonary circulation and those of you who saw, who have looked at the lectures in cardiology have seen that finding emphasize at that time.

00:48 Patient has dyspnea, there's a sign of pulmonary hypertension with a loud pulmonic sound, and she has peripheral edema suggesting some heart failure.

00:58 And here is the cardiogram. Take a look at it for a few minutes.

01:08 What are we seeing? First of all, tall R waves in lead V1.

01:14 Secondly, deep S waves in lead AVL, that's in the red box. And also look at the blue box.

01:23 It's showing you right atrial hypertrophy. Spiky, right atrial hypertrophy P wave pattern.

01:32 So, the diagnosis is right ventricular hypertrophy and it's secondary to pulmonary hypertension.

01:41 Thanks very much for participating in this lecture and we look forward to talking some more about ECG patterns with you.