Tracing from a 14Year-Old Girl

Secundum atrial septal defect

The electrocardiogram shown above was recorded from a 14year-old girl. What disease process would cause such an
abnormality? Select the correct answer from the
following list.
A) Mitral valve regurgitation due to rheumatic heart disease. B) Aortic
valve stenosis.
C) Secundum atrial septal defect. D) Congenital tricuspid valve
atresia.

Answer
C) Secundum atrial septal defect. is correct.
The abnormalities shown in this tracing are commonly present in
patients with ostium secundum atrial septal defect. There is a hint in
this tracing that a right atrial abnormality is present. The QRS duration
is 0.10 second. The mean QRS vector is directed to the right and
anteriorly. The terminal 0.04 portion of the QRS complex is directed to
the right, superiorly, and anteriorly (Fig. 2). This is characteristic of
right ventricular conduction delay.

Discussion
The electrocardiogram of young patients with an ostium secundum
atrial septal defect will show right ventricular conduction delay. The
terminal portion of the QRS complex will be directed to the right,
superiorly, and anteriorly. This produces an rsR configuration of the
QRS complex in lead V1. The PR interval may be prolonged and a right
atrial abnormality may be present. As time passes the tracing may
change to show right bundle branch block.
Right ventricular conduction delay may occur in an otherwise normal
heart but the wise physician always considers the presence of a
secundum atrial septal defect.