Congenital Heart Disease

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    22 year old woman with a sternotomy scar.

    22 year old woman with a sternotomy scar.

    Key Findings

    - Atrial pacing with an inverted P vector in I and V1

    - Anterior and Rightward prominence

    Coding for the Boards

    -Atrial pacing

    -Right axis deviation

    -Right ventricular hypertrophy

    -ST Abnormal secondary to hypertrophy

    Answers

    Discussion: This is a classic EKG of a patient with the transposition of the great vessels and Mustard procedure. The atrial pacing vector suggests that the atrial lead is placed in the left atrial appendage. The right axis deviation and right ventricle hypertrophy are due to the fact that the anatomic right ventricle is the sub aortic ventricle.