Cyanotic heart defect electrocardiogram

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Electrocardiogram

The normal neonatal electrocardiogram (ECG) has right axis deviation (QRS axis +90 to +180 degrees) and a precordial pattern of right ventricular hypertrophy.

• Lesions associated with a small right ventricle have the following:

• • Left axis deviation for age (for pulmonary atresia intact ventricular septum typically +30 to +90 degrees; for tricuspid atresia with normally related great arteries typically -30 to -90 degrees)

• • Right atrial enlargement – Tall peaked P waves most easily identified in lead II

• • Left ventricular hypertrophy

• Hypoplastic left heart syndrome often has marked right ventricular hypertrophy and decreased left ventricular forces in the lateral precordial leads.

• Ebstein's anomaly has signs of right atrial enlargement or tall and broad 'Himalayan' P waves.

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