Atrial septal defect with severe pulmonary hypertension
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ECG in atrial septal defect with severe pulmonary hypertension. rSR’ pattern is seen in V1 with a tall R’, possibly reflecting right ventricular hyperterophy. The strain pattern is extensive, from V1 to V6. RSR pattern is seen in III and aVF as well. The QRS duration is also increased. Echocardiogram in this case confirmed a large secundum atrial septal defect with severe pulmonary hypertension and bidirectional shunt.