Mitral regurgitation electrocardiogram: Difference between revisions

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VisualWikitext

Latest revision as of 15:44, 23 January 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed A. Sbeih, M.D.[2]; Rim Halaby, M.D. [3]

Overview

In severe cases of chronic mitral regurgitation (MR), signs of left ventricular hypertrophy with strain, left atrial enlargement, and pulmonary hypertension may be observed on the resting electrocardiogram (ECG). Chronic mitral regurgitation is associated with an increased risk for atrial fibrillation. The ECG may reveal findings of coronary artery disease or other cardiac conditions that might have led to MR.

Electrocardiogram

Left Atrial Enlargement

ECG findings suggestive of left atrial enlargement include:^[1]^[2]

Broad, bifid P wave in lead II (P mitrale)
Enlargement of the terminal negative portion of the P wave in VI.
P wave amplitude >2.5mm in inferior leads (II, III, AVF) or >1.5mm in V1/V2 (P pulmonale)

Shown below is an ECG depicting the following in lead II:

Bifid P wave with > 40 ms between the two peaks
Total P wave duration > 110 ms

Shown below is an ECG depicting the following in lead V1:

Biphasic P wave with terminal negative portion > 40 ms duration
Biphasic P wave with terminal negative portion > 1mm deep

Left atrial enlargement as seen in lead V1

Left Ventricular Enlargement

Left ventricular enlargement is associated with an increased QRS voltage on ECG and a strain pattern or inverted check mark pattern to the T wave in the lateral leads.

Pulmonary Hypertension

ECG findings suggestive of pulmonary hypertension include:

Right axis deviation
R/S ratio > 1 in V1
R wave > 7mm in V1
rSR' complex in V1 with R' > 10mm
qR complex in V1
Right ventricular strain pattern: ST segment and T wave inversion in V1-V3 and occasionally in inferior leads (II, III, AVF)
Right bundle branch block: QRS duration> 0.12 seconds, rSR' in leads V1 & V2, wide slurred S waves in lateral leads (V5, V6, I)

Atrial Fibrillation

Atrial fibrillation is commonly seen with mitral regurgitation: This is identified as an irregularly irregular rhythm with absence P waves.

References

↑ Murphy PJ (1985). "Searching in the dark". Drug Metab. Dispos. 13 (3): 269–71. PMID 2861980.
↑ O'Keefe, James (2008). The Complete Guide to ECGS. Jones & Bartlett Pub. ISBN 0-7637-6405-1.

Template:WikiDoc Sources

[pmid2861980-1] Murphy PJ (1985). "Searching in the dark". Drug Metab. Dispos. 13 (3): 269–71. PMID 2861980.

[isbn0-7637-6405-1-2] O'Keefe, James (2008). The Complete Guide to ECGS. Jones & Bartlett Pub. ISBN 0-7637-6405-1.

[1]

[2]

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-| [[File:Siren.gif|30px|link=Mitral Regurgitation intern survival guide]]|| <br> || <br>
+| [[File:Siren.gif|30px|link=Mitral regurgitation resident survival guide]]|| <br> || <br>
-| [[Mitral Regurgitation intern survival guide|Intern <br> Survival   <br> Guide]]
+| [[Mitral regurgitation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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 {{Mitral regurgitation}}
-{{CMG}}; '''Associate Editor-In-Chief:''' [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]][mailto:msbeih@wikidoc.org].
+{{CMG}}; {{AE}} [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]][mailto:msbeih@wikidoc.org]; {{Rim}}
 ==Overview==
-In severe cases of mitral regurgitation, [[left ventricular hypertrophy with strain]]; [[left atrial enlargement]], and signs of [[pulmonary hypertension]] may be observed on the resting EKG. Chronic mitral regurgitation is associated with an increased risk for [[atrial fibrillation]].
+In severe cases of chronic mitral regurgitation (MR), signs of [[left ventricular hypertrophy with strain]], [[left atrial enlargement]], and [[pulmonary hypertension]] may be observed on the resting [[electrocardiogram]] ([[ECG]]). Chronic mitral regurgitation is associated with an increased risk for [[atrial fibrillation]].  The ECG may reveal findings of [[coronary artery disease]] or other cardiac conditions that might have led to MR.
 ==Electrocardiogram==
-'''1.''' [[LA enlargement]]: [[Left atrial enlargement]] produces a broad, bifid [[P wave]] in lead II ('''P mitrale''') and enlarges the terminal negative portion of the P wave in VI.
+===Left Atrial Enlargement===
+ECG findings suggestive of [[left atrial enlargement]] include:<ref name="pmid2861980">{{cite journal |vauthors=Murphy PJ |title=Searching in the dark |journal=Drug Metab. Dispos. |volume=13 |issue=3 |pages=269–71 |date=1985 |pmid=2861980 |doi= |url=}}</ref><ref name="isbn0-7637-6405-1">{{cite book |author=O'Keefe, James |title=The Complete Guide to ECGS |publisher=Jones & Bartlett Pub |location= |year=2008 |pages= |isbn=0-7637-6405-1 |oclc= |doi= |accessdate=}}</ref>
-In '''lead II''' following may be seen:
+* Broad, bifid [[P wave]] in lead II ('''P mitrale''')
+* Enlargement of the terminal negative portion of the P wave in VI.
+* P wave amplitude >2.5mm in inferior leads (II, III, AVF) or >1.5mm in V1/V2 ('''P pulmonale''')
+Shown below is an ECG depicting the following in lead II:
 *Bifid [[P wave]] with > 40 ms between the two peaks
 *Total [[P wave]] duration > 110 ms
@@ Line 20: / Line 25: @@
 ----
-In '''lead V1''', the following may be seen:
+Shown below is an ECG depicting the following in lead V1:
 *Biphasic [[P wave]] with terminal negative portion > 40 ms duration
 *Biphasic [[P wave]] with terminal negative portion > 1mm deep
 [[Image:LAE-v1.png|Left atrial enlargement as seen in lead V1|center|500px]]
-----
-'''2.''' [[Atrial fibrillation]] is commonly seen with mitral regurgitation: This is identified as an irregularly irregular rhythm with absence [[P waves]].
+===Left Ventricular Enlargement===
+Left ventricular enlargement is associated with an increased [[QRS]] voltage on ECG and a strain pattern or inverted check mark pattern to the T wave in the lateral leads.
-Below is an '''ECG in mitral regurgitation'''. Note the evidence of [[left atrial enlargement]] in lead V1:
+===Pulmonary Hypertension===
+ECG findings suggestive of pulmonary hypertension include:
+*[[Right axis deviation]]
+*R/S ratio > 1 in V1
+*R wave > 7mm in V1
+*rSR' complex in V1 with R' > 10mm
+*qR complex in V1
+*Right ventricular strain pattern: [[ST segment]] and [[T wave]] inversion in V1-V3 and occasionally in inferior leads (II, III, AVF)
+*[[Right bundle branch block]]: [[QRS]] duration> 0.12 seconds, rSR' in leads V1 & V2, wide slurred [[S wave]]s in lateral leads (V5, V6, I)
-[[Image:LAE_12lead.jpg|Left atrial enlargement, a 12 lead ECG|center|500px]]
+===Atrial Fibrillation===
-----
+[[Atrial fibrillation]] is commonly seen with mitral regurgitation: This is identified as an irregularly irregular rhythm with absence [[P waves]].
 ==References==