November 1983

ECG Criteria for Right Atrial Enlargement

Author Affiliations

From the Cardiology Division, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey. Dr Reeves is now with Mount Sinai Hospital, Milwaukee.

Arch Intern Med. 1983;143(11):2155-2156. doi:10.1001/archinte.1983.00350110141029

In 1978, an ECG task force reported that the detection of right atrial enlargement should be based on the presence of an increase in P wave amplitude in the limb leads, in association with a peaked P wave morphology, and rightward frontal plane P wave axis.1 This pattern is known as P pulmonale (Fig 1, upper trace). This suggestion has some support in two autopsy studies. Berliner and Master,2 in 1938, reported that subjects with isolated left atrial hypertrophy had normal P wave amplitude, while those with biatrial hypertrophy had an increase in P wave amplitude, although in four cases of isolated right atrial hypertrophy, no P wave abnormalities were noted. In 1962, Caird and Wilken3 found right atrial abnormalities in patients with obstructive lung disease. The P pulmonale ECG pattern was noted in seven of the 11 patients with a dilated right atrium, three patients with

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