Radiographic and electrocardiographic features of pulmonary hypertension

This figure shows the radiographic and electrocardiographic (EKG) features of pulmonary hypertension.
(A, B) These images show the radiographic appearance of right ventricular hypertrophy in a 26 year-old man with severe heritable pulmonary artery hypertension (PAH). The posteroanterior (PA) image (image A) reveals bilateral enlargement of the central pulmonary arteries (arrowheads) with attenuation of the peripheral vessels (arrows) and a prominent right heart border (short arrow). The lateral projection (image B) reveals diminution of the retrosternal space (block arrow) consistent with right ventricle hypertrophy.
(C-F) Image C shows a normal EKG. Shown in image D is right axis deviation and an R wave/S wave ratio greater than one in lead V1 with deep T-wave inversion in V1 through V5 consistent with right ventricular hypertrophy/strain. There is no right bundle branch block on this EKG. In image F, another EKG shows increased P wave amplitude in lead II (P pulmonale) due to right atrial enlargement; this compares with left atrial enlargement that has notched and prolonged P waves seen in image E.