Mitral stenosis electrocardiogram

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Electrocardiographic Findings

• LA enlargement (P mitrale): 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.

In lead II following may be seen:

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

In lead V1 follwing may be seen:

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

• Right ventricular hypertrophy: A mean QRS axis in the frontal plane is greater than 80 and an R-to-S ratio of greater than 1 in lead V1.
• Right axis deviation: mean QRS axis in the frontal plane moves toward the right as pulmonary hypertension worsens
• Atrial fibrillation is commonly seen with mitral stenosis: Irregularly irregular rhythm with absence P waves

ECG in mitral stenosis