Right Atrial Enlargement

AKA: Right atrial hypertrophy, right atrial abnormality

Attention! Before reading this page, check out our introduction to the P wave for an explanation of the basics of atrial enlargement.

Electrocardiographic Criteria

Right atrial enlargement produces a peaked P wave (P pulmonale) with amplitude:

• > 2.5 mm in the inferior leads (II, III and AVF)
• > 1.5 mm in V1 and V2

Causes

The principal cause is pulmonary hypertension due to:

• Chronic lung disease (cor pulmonale)
• Tricuspid stenosis
• Congenital heart disease (pulmonary stenosis, Tetralogy of Fallot)
• Primary pulmonary hypertension

Examples

Right atrial enlargement: P wave amplitude > 2.5mm in leads II, III and aVF

Right atrial enlargement: P wave amplitude > 1.5 mm in V2

Related Topics

• The P Wave
• Left Atrial Enlargement
• Biatrial Enlargement

Further Reading

• ECG BASICS – Waves, Intervals, Segments and Clinical Interpretation
• ECG CLINICAL CASES – Your favourite ECG’s placed in clinical context with a challenging Q&A approach
• ECG and Cardiology Eponymous Syndromes – Cheats guide to eponymous emancipation
• ECG Reference Sites on the WEB – the best of the rest

Author Credits

• Words – Ed Burns
• Pictures - Ed Burns
• Web Editing – Ed Burns

References

• Chung DC, Nelson HM. ECG – A Pictorial Primer [internet]. Accessed 12/12/2011.
• Edhouse J, Thakur RK, Khalil JM. ABC of clinical electrocardiography. Conditions affecting the left side of the heart. BMJ. 2002 May 25;324(7348):1264-7. Review. PubMed PMID: 12028984; PubMed Central PMCID: PMC1123219 [Full Text].
• Harrigan RA, Jones K. ABC of clinical electrocardiography. Conditions affecting the right side of the heart. BMJ. 2002 May 18;324(7347):1201-4. Review. PubMed PMID: 12016190; PubMed Central PMCID: PMC1123164 [Full Text].
• Jenkins RD, Gerred SJ. ECGs by Example. Second Edition. Elsevier Churchill Livingstone 2005.
• Phibbs, BP. Advanced ECG: Boards and Beyond (2^nd Edition), Saunders Elsevier 2006.
• Surawicz B, Knilans TK. Chou’s Electrocardiography in Clinical Practice. 6th Edition. Saunders Elsevier 2008.
• Wagner, GS. Marriott’s Practical Electrocardiography (11th edition), Lippincott Williams & Wilkins 2007.