Mitral regurgitation electrocardiogram

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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

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 I/II the following may be seen:

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

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In lead V1, the following may be seen:

• 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

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.

Below is an ECG in mitral regurgitation. Note the evidence of left atrial enlargement in lead V1:

Left atrial enlargement, a 12 lead ECG

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References

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