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(Circulation. 2003;107:1679.)
© 2003 American Heart Association, Inc.

Images in Cardiovascular Medicine

Dramatic Left Atrial and Ventricular Hypertrophy in an Adult With Cyanotic Congenital Heart Disease

Rajesh Sachdeva, MD; Craig A. McPherson, MD; John T. Fahey, MD; Stuart W. Zarich, MD

From the Division of Cardiology, Department of Medicine, Bridgeport Hospital, Yale University School of Medicine, Bridgeport (R.S., C.A.M., S.W.Z.), and the Division of Pediatric Cardiology, Yale New Haven Hospital, Yale University School of Medicine, New Haven (J.T.F.), Conn.

Correspondence to Stuart W. Zarich, MD, Chief, Division of Cardiology, Bridgeport Hospital, 267 Grant St, P O Box 5000, Bridgeport, CT 06610. E-mail pszari@bpthosp.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 29-year-old man with history of atrial tachyarrhythmias and a remote Potts anastomosis for treatment of tricuspid atresia presented with palpitations and chest pain. His medications included digoxin, furosemide, prednisone, methimazole, and amiodarone. He was afebrile. His pulse was 176 beats per minute with a blood pressure of 160/80 mm Hg. He was cyanotic with clubbed fingers and toes. The apical impulse was displaced to the 6th intercostal space in the mid-axillary line. Auscultation revealed normal S1, single S2, and a short systolic murmur arising from the Potts shunt that was heard over the left precordium and back. No diastolic component was appreciated.

Chest radiography revealed cardiomegaly with prominent pulmonary vasculature and enlarged pulmonary arteries. The admission ECG showed supraventricular tachycardia (SVT) at 176 beats per minute (Figure 1A) that terminated with intravenous adenosine injection. The subsequent ECG in sinus rhythm (Figure 1B) demonstrated marked atrial and left ventricular hypertrophy. The P waves in V₁ during tachycardia (Figure 1A) were so large that they were initially misconstrued as being T waves. The QRS voltage was the largest recorded in our laboratory (106 mV in V₆). Echocardiography demonstrated findings consistent with tricuspid atresia and a Potts (direct descending aorta to left pulmonary artery) shunt. The left ventricle was markedly dilated and hypertrophied, with an end-diastolic dimension of 60 mm and wall thickness of 18 mm; there was marked bi-atrial enlargement, and right-to-left shunting across the atrial septal defect (Figure 2). Doppler examination . . . [Full Text of this Article]