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10 Possible Causes for P Pulmonale, Poor R Wave Progression, Pulmonary Systolic Murmur

  • Eisenmenger Syndrome

    ECG: almost always abnormal; shows features suggestive of right heart hypertrophy (with tall R wave in V1, deep S wave in V6, ST and T wave abnormalities, P pulmonale) as[] Along the left sternal border systolic murmur can be heard, and early pulmonary systolic shock.[] Ejection systolic murmur audible along the left sternal border.[]

  • Cor Pulmonale

    R wave progression RAE with and RVH multifocal atrial tachycardia return to top Differential Diagnosis return to top Treatments Consequences and Course return to top The[] In ECG, P pulmonale was observed in 58 (99.66%) of cases. 48 (80%) were having right ventricular dilatation and right atrial dilation was observed in 30 (50%) of patients.[] Split second heart sound with loud pulmonary component. Systolic ejection murmur with a sharp ejection click over the pulmonary artery (advanced sign).[]

  • Pulmonary Embolism

    Electrocardiographic findings ACS ( n 198) APE ( n 81) TC ( n 21) p value P pulmonale (%) 8 (4) 10 (12) 0 0.014 Right axis deviation (%) 0 6 (7) 0 Left axis deviation (%)[] Signs of pulmonary hypertension, such as palpable impulse over the second left intercostal space, loud P 2, right ventricular S 3 gallop, and a systolic murmur louder on inspiration[] pulmonale, right-axis deviation, ST-segment elevation, ST-segment depression, QT prolongation, and incomplete or complete right bundle-branch block. 30, 93 – 110 Of these,[]

  • Acute Cor Pulmonale

    Peaked P waves in the inferior leads 2.5 mm (P pulmonale) with a rightward P-wave axis (inverted in aVL) Clockwise rotation of the heart with a delayed R/S transition point[] […] and pulmonic insufficiency murmurs, and later, distended jugular veins, hepatomegaly, and lower-extremity edema.[] Cor pulmonale is RV enlargement and eventually failure secondary to a lung disorder that causes pulmonary artery hypertension.[]

  • Anterior Myocardial Infarction

    The remarkable feature is the poor R wave progression in the V1 and V2 leads and the ST elevation and T wave changes in leads V1 to V4 and I and aVL.[] […] as R/S ration 1 in V1 or V2 Normal variant (if rest of the ECG is normal) True posterior MI (look for evidence of inferior MI) RVH (should see RAD in frontal plane and/or P-pulmonale[] Third and fourth heart sound, systolic murmur if mitral regurgitation or ventricular septal defect develops, pericardial rub.[]

  • Pulmonary Arteritis

    R wave progression RAE with and RVH multifocal atrial tachycardia return to top Differential Diagnosis return to top Treatments Consequences and Course return to top The[] Echocardiography showed normal right ventricular systolic function with no evidence of pulmonary arterial hypertension.[] Cardiac examination showed systolic heart murmur over the broad area of the precordium, propagating to the pulmonary valve diastolic heart murmur over the left sternal border[]

  • Right Ventricular Hypertrophy

    Figure 3 shows atrial fibrillation, poor R wave progression, and diffuse ST-segment abnormalities in an ECG from a patient with ischemic cardiomyopathy.[] Supporting criteria Right atrial enlargement (P pulmonale).[] On auscultation, an accentuated second pulmonary sound (S2), a third heart sound termed a ‘right ventricular gallop’, as well as a systolic murmur over the tricuspid area[]

  • Heart Failure

    Electrocardiography demonstrated poor R-wave progression in leads V1-V3 with right axis deviation and low voltage criteria.[] In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed.[] The characteristic apical systolic murmur may be absent in patients with severe MR, due to the abrupt and severe elevation of left atrial pressure.[]

  • Acute Atrial Infarction

    In contrast, poor R wave progression is commonly observed with LVH and with acute or chronic right ventricular overload.[] He had an irregular heart rate and an apical systolic murmur /6 . Inferior limb edema, as well as varicose veins, were not noted.[] The presence of low limb voltage and P pulmonale can serve as additional diagnostic clues.[]

  • Paradoxical Embolism

    The electrocardiogram showed sinus rhythm (heart rate 61 bpm), first-degree atrioventricular block, right atrial abnormality, poor R-wave progression in the anterior wall[] pulmonale, S 1 Q 3 T 3 pattern, or right ventricular hypertrophy.[] Cardiac auscultation revealed a systolic murmur at the left lower sternal border and a splitting of the second heart sound in the pulmonary area.[]