Right atrial enlargement

My 10-year-old child had an EKG which showed possible right atrial enlargement.  He has also mentioned that he occasionally is short of breath even in a resting position.  He is otherwise healthy.  What could be the cause of this?

[Marie M Gleason, M.D.]

Electrocardiograms (ECG) are very helpful as a general screen for cardiac issues, but the information provided is not always specific.  There are many times where we see minor "abnormalities" (waves or intervals that measure just above the upper limit of normal) on an ECG that ultimately turn out to be nothing.  Hence the term "possible".  Once an abnormality is noted on a ECG, and the patient has symptoms, it is important to follow through, and consider a cardiology evaluation.  In your child's case, the ECG finding may, in fact, be just a normal variant.  However, there are cardiopulmonary issues that can be detected for the first time even in a 10 year old, such as an atrial septal defect (ASD)- a hole between the upper heart chambers that can lead to right atrial enlargement, or elevated pressure in the lungs, called pulmonary hypertension.  On physical examination, there may be subtle abnormalities of the heart sounds with these conditions, with or without a heart murmur. You should speak with your primary doctor about these concerns, and then determine if evaluation by a heart specialist is indicated.