What EKG feature suggests right atrial enlargement?

Peaked P waves in leads II and V1 are indicative of right atrial enlargement. This characteristic pattern occurs because the right atrium becomes enlarged and generates a larger than normal electrical impulse. As this impulse is recorded on the EKG, it manifests as tall, pointed P waves, primarily in the aforementioned leads. In lead II, the P wave represents atrial depolarization oriented towards the lead, while in lead V1, it captures the vector of the depolarization that would typically reflect the size and functionality of the right atrium.

In contrast, other EKG features do not directly indicate right atrial enlargement. Widened QRS complexes are more often associated with ventricular hypertrophy or conduction blocks, inverted T waves usually suggest ischemia or other cardiac conditions, and depressed ST segments can indicate ischemia or electrolyte imbalances. Thus, the presence of peaked P waves is the clearest sign of right atrial enlargement on an EKG.