Mitral regurgitation electrocardiogram: Difference between revisions
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==Electrocardiogram== | ==Electrocardiogram== | ||
===Left Atrial Enlargement=== | ===Left Atrial Enlargement=== | ||
[[ | ECG findings suggestive of [[left atrial enlargement]] include: | ||
* 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 | *Bifid [[P wave]] with > 40 ms between the two peaks | ||
*Total [[P wave]] duration > 110 ms | *Total [[P wave]] duration > 110 ms | ||
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---- | ---- | ||
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 > 40 ms duration | ||
*Biphasic [[P wave]] with terminal negative portion > 1mm deep | *Biphasic [[P wave]] with terminal negative portion > 1mm deep | ||
Revision as of 20:45, 8 September 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed A. Sbeih, M.D.[2].
Overview
In severe cases of mitral regurgitation, signs of left ventricular hypertrophy with strain, left atrial enlargement, and pulmonary hypertension may be observed on the resting electrocardiogram. Chronic mitral regurgitation is associated with an increased risk for atrial fibrillation.
Electrocardiogram
Left Atrial Enlargement
ECG findings suggestive of left atrial enlargement include:
- 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:
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 Ventricular Enlargement
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)[1]
Atrial Fibrillation
Atrial fibrillation is commonly seen with mitral regurgitation: This is identified as an irregularly irregular rhythm with absence P waves.
Below is an ECG in mitral regurgitation. Note the evidence of left atrial enlargement in lead V1:
References
- ↑ O'Keefe, James (2008). The Complete Guide to ECGS. Jones & Bartlett Pub. ISBN 0-7637-6405-1.