A 25-day-old neonate presented with cyanosis along with sweating and difficulty in feeding. There is history of mother taking some drug in the 1st trimester for her bipolar disease. O/E: - Holosystolic murmur parasternally in the left 4th intercostal space which increased on inspiration S3 and S4 hea sounds. ECG of the neonate Which is the embrological remnant associated with this condition?

This is a case of Ebstein's anomaly presenting with cyanosis and signs of congestive hea failure. ECG findings Signs of right atrial enlargement, best seen in V1. P waves are broad and tall, these are termed "Himalayan" P waves. Right bundle branch block pattern First-degree atrioventricular block (prolonged PR-interval) T-wave inversion in V1-4 Marked Q wave in III These changes are characteristic for Ebstein's anomaly and do not reflect ischemic ECG changes in this patient Ebstein anomaly Consists of downward displacement of an abnormal tricuspid valve into the right ventricle. The right atrium is enlarged as a result of tricuspid valve regurgitation. Present with marked cyanosis, massive cardiomegaly, and long holosystolic murmurs. Wolff-Parkinson- white syndrome may be present. Supraventricular tachycardia. Occurs due to lithium intake in 1st trimester.