Systolic ejection murmur and notching of the R wave in the inferior leads

ECG Weekly Workout with Dr. Amal Mattu


A 22-year-old man presents to his PCP for a routine medical exam needed for work. He is asymptomatic with normal vital signs, but a 2/6 systolic ejection murmur is heard on exam. The murmur is best heard in the pulmonic area, where a fixed split S2 is also noted. The following ECG was obtained:

Before watching this week’s video, ask yourself these questions:

  1. What ECG abnormalities do you notice?
  2. What is your differential for the described murmur?
  3. What is the name of the diagnostic ECG pattern seen in the limb leads?