English: 12-lead ECG of a woman with Ebstein's anomaly (a congenital heart defect in which the opening of the tricuspid valve is displaced towards the apex of the right ventricle of the heart, resulting in a large right atrium). The ECG shows signs of right atrial enlargement, best seen in V1. Other P waves are broad and tall, these are termed "Himalayan" P waves. There is also a right bundle branch block pattern and a first degree atrioventricular block (prolonged PR-interval) due to intra-atrial conduction delay. There is no evidence of a Kent-bundle in this patient. There is T wave inversion in V1-4 and a marked Q wave in III; these changes are characteristic for Ebstein's anomaly and do not reflect ischemic ECG changes in this patient.