CardioNerds ECG Challenge #5

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16 year-old Saudi Arabian boy presents with dyspnea, weakness and heart failure. He was born with a normal heart and has no history of trauma.​

Can you interpret this ECG


  1. Sinus bradycardia at 56/min​
  2. RA abnormality/enlargement​
  3. LA abnormality/enlargement​
  4. AV block, 1⁰​
  5. Right axis deviation (+127⁰)​
  6. Right ventricular hypertrophy

This is rheumatic heart disease. The primary valve lesion was mitral stenosis which resulted in massive left atrial enlargement, pulmonary hypertension, right ventricular hypertrophy, right atrial enlargement and heart failure, first left, then right.  While having a tall R wave in V1 is the most common EKG pattern for RVH, in young patients with mitral stenosis like presented here, RVH can be diagnosed on the basis of right axis deviation and posterior axis deviation with poor R wave progression and large S waves in the lateral precordial leads.​

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CardioNerds ECG Challenge #5