‘Himalayan P waves’ in ECG is characteristic of:: (A) Atrial septal defect, (B) Eisenmenger syndrome, (C) Tetralogy of Fallot, (D) Ebstein’s anomaly
Answer is D. 12 – lead ECG

Rarely normal
Abnormal P waves consistent with right atrial enlargement – ‘Himalaya P waves”.
RBBB in 75-92%
PR prolongation is common due to RA enlargment
Ventricular pre-excitation 10-30%