UMEM Educational Pearls

Ebstein's Anomaly

  • Congenital defect of the tricuspid valve (TV) and the right ventricle (RV)
  • TV septal and posterior leaflets are apically displaced resulting in "atrialization" of a portion of the right ventricle (ultimately a large right atrium and small right ventricle)
  • ~40-50% of individuals with Ebstein anomaly have evidence of Wolf-Parkinson-White, secondary to the atrialized right ventricle
  • ECG abnormalities include:
    • Right atrial enlargement or tall and broad P waves (Himalayan P waves) 
    • Prolonged PR interval
    • Right bundle branch block 
    • Low amplitude QRS complexes in the right precordial leads
    • T wave inversions V1-V4 and/or Q waves V1-V4

References

Osiro S, Tiwari K, Mathenge N, et al. When Lithum Hurts: A Look at Ebstein Anomaly. Cardiology in Review. Oct 2013, Vol 21(5); pgs 257-263.