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* Normal QRS complex | * Normal QRS complex | ||
* No delta wave | * No delta wave | ||
==Ebstein== | |||
In Ebstein anomaly the tricuspid valve is inserted more apically than normal. This yields a very large right atrium. About 50% of individuals with Ebstein's anomaly have evidence of Wolff-Parkinson-White syndrome, secondary to the atrialized right ventricular tissue. | |||
Other abnormalities that can be seen on the ECG include | |||
#signs of right atrial enlargement or tall and broad 'Himalayan' P waves, | |||
#first degree atrioventricular block manifesting as a prolonged PR-interval | |||
#low amplitude QRS complexes in the right precordial leads | |||
#atypical right bundle branch block | |||
#T wave inversion in V1-V4 and Q waves in V1-V4 and II, III and aVF. | |||
#Q waves in II, III, AVF. These Q waves are thought to reflect fibrotic thinning of the right ventricular free wall and/or septal fibrosis with coexisting left posterior hemiblock<cite>khairy</cite> | |||
[[File:E000403.jpg|thumb|ECG from a patient with Ebstein's anomaly showing huge P waves and low amplitude QRS waves. RBBB and T wave inversion are not present on this ECG.]] | |||
==Left and right bundle branch block== | ==Left and right bundle branch block== | ||
See: [[Conduction_delay|Conduction delay]] | See: [[Conduction_delay|Conduction delay]] | ||
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#Maron pmid=14681516 | #Maron pmid=14681516 | ||
#hypoth pmid=2738372 | #hypoth pmid=2738372 | ||
#khairy pmid=18056539 | |||
</biblio> | </biblio> | ||
}} | }} | ||
[[Category:ECG Textbook]] | [[Category:ECG Textbook]] |