| | Congenital Heart Disease in Adults |
 | | The difference between the electrocardiographic abnormalities produced by congenital heart disease, such as pulmonary valve stenosis (A), and those produced by the early stages of acquired disease, such as mitral stenosis (B). |
 | | This type of abnormality occurs with congenital disease, such as pulmonary valve stenosis, or advanced acquired disease, such as mitral stenosis with moderately severe pulmonary hypertension. |
 | | Early in the natural history of right ventricular hypertrophy due to acquired heart disease, such as mitral stenosis or primary pulmonary hypertension, the mean QRS vector tends to have an intermediate or vertical direction; it usually retains a slightly posterior direction. |
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