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Patient
57-year-old woman with primary pulmonary arterial hypertension followed in the department; recording of several tracings over an extended 6-year period;
Trace
This tracing shows sinus rhythm, first degree atrioventricular block (PR interval 205 ms), narrow QRS, right axis deviation (116°), signs of right ventricular hypertrophy with a R/S ratio > 1 in V1 and repolarization disorders in the right precordial leads (V1 to V4);
Trace
Tracing recorded 2 years after the initial tracing; slight increase in PR interval (228 ms); increase in right rotation (131°) and increase of the amplitude of the R wave in V1;
Trace
Tracing recorded 6 years after the initial tracing; increase in the amplitude of the R wave in V1, V2, V3;
Exergue
The electrocardiogram lacks sensitivity and specificity to be used as a standalone for the diagnosis of PAH. On the other hand, the electrical abnormalities allow to follow the evolution of the disease. The recording of electrocardiograms repeated over time can highlight the presence of a right axis rotation, a dominant R wave in V1 (> 0.5 mm, R/S ratio> 1 and progression of the R wave amplitude), a right bundle branch block, repolarization disorders with T-wave inversion in the right precordium.
Pulmonary arterial hypertension (PAH) is a rare and severe pulmonary vascular disease defined by an increase in pulmonary arterial resistance, which can progress to right heart failure.