Ventricular septal defect electrocardiogram

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Electrocardiogram

Small VSD: EKG is normal. A few patients will have an rsr' in V1.

Medium-sized VSD: in the adolescence with this type of defect, or a moderate left-to-right shunt, the EKG may show LVH, and in addition there may be mild RVH in lead V1 with an rsR' pattern.

Large VSD: In adults or adolescence with a large VSD and pulmonary vascular obstructive disease, LVH is absent because volume overload of the LV is no longer present. At this point there is either an rsR' pattern in the right precordial leads, or more commonly, a tall monophasic R wave in the right precordial leads reflecting RVH. Also deep S waves in the lateral precordial leads and tall peaked P waves.

In patients with an acquired infundibular stenosis, the EKG shows a pattern of RVH similar to the tracing of patients with tetralogy of Fallot.