ECG

The ECG is often but not always abnormal in pulmonary arterial hypertension.  The most sensitive feature is RV strain (ST depression and T wave inversion in leads V1 to V3).  Other changes found include right axis deviation, P pulmonale, right bundle branch block, tall R waves especially anteriorly and prolonged QTc. 

 

ECG.jpg

Figure 1.  Typical ECG changes in IPAH 

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