BMJ Case Reports 2016; doi:10.1136/bcr-2016-217817

‘Crochetage’ sign on ECG in secundum ASD: clinical significance

  1. Pranab Jyoti Bhattacharyya
  1. Department of Cardiology, Guwahati Medical College, Guwahati, Assam, India
  1. Correspondence to Dr Pranab Jyoti Bhattacharyya, drpranabguwahati{at}
  • Accepted 23 September 2016
  • Published 8 October 2016


A 50-year-old woman with no cardiovascular risk factors was evaluated for easy fatigability and progressive dyspnoea on exertion for the last 1 year. Cardiac auscultation revealed a normal first heart sound, an ejection systolic murmur at the upper left sternal border and wide and fixed splitting of the second heart sound. The ECG demonstrated sinus rhythm, incomplete right bundle branch block (RBBB) and ‘crochetage’ sign (notch near the apex of the R wave) in inferior limb leads (figure 1). There was evidence of cardiomegaly, dilated main pulmonary artery …

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