Right Atrial Enlargement

ECG Criteria of Right Atrial Enlargement

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

Also known as: Right Atrial Enlargement (RAE), Right atrial hypertrophy (RAH), right atrial abnormality

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P wave changes with Right Atrial Enlargement

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Causes of Right Atrial Enlargement

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

ECG Examples

Example 1

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

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Example 2

• Right atrial enlargement: P wave amplitude > 1.5 mm in V1 and V2

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Related Topics

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References

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Advanced Reading

Online

Textbooks

• Zimmerman FH. ECG Core Curriculum. 2023
• Mattu A, Berberian J, Brady WJ. Emergency ECGs: Case-Based Review and Interpretations, 2022
• Straus DG, Schocken DD. Marriott’s Practical Electrocardiography 13e, 2021
• Brady WJ, Lipinski MJ et al. Electrocardiogram in Clinical Medicine. 1e, 2020
• Mattu A, Tabas JA, Brady WJ. Electrocardiography in Emergency, Acute, and Critical Care. 2e, 2019
• Hampton J, Adlam D. The ECG Made Practical 7e, 2019
• Kühn P, Lang C, Wiesbauer F. ECG Mastery: The Simplest Way to Learn the ECG. 2015
• Grauer K. ECG Pocket Brain (Expanded) 6e, 2014
• Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric 6e, 2008
• Chan TC. ECG in Emergency Medicine and Acute Care 1e, 2004

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LITFL Further Reading

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