Abnormal electrocardiogram obtained after
an automobile accident

D. Luke Glancy, MD, Darrin G. Merwin, BS, Karthik Reddy, MD, and Mark Cassidy, MD

A 24-year-old previously asymptomatic man suffered a fracture of his femur in an automobile accident. Because he also complained of chest pain after the accident, an electrocardiogram was obtained. It shows sinus rhythm with tall (>2.5 mm in lead II and >1.5 mm in leads V₁ and V₂) and broad (0.12 seconds in the precordial leads) P waves indicating atrial enlargement, predominantly right. The QRS complexes are wide (0.13 seconds), with broad S waves in leads I and V₆, broad R waves in lead aVR, and a multiphasic (rSŕś) configuration of relatively low voltage in the anterior precordial leads. Thus, the pattern is that of atypical right bundle branch block. These findings do not suggest a myocardial contusion, which was the point of concern, but are typical of Ebstein's anomaly of the tricuspid valve (1, 2), a diagnosis that was confirmed by echocardiography.