DIAGNOSIS: Normal sinus rhythm; left atrial enlargement.
The negative component of the P wave in lead V 1 is 1 mm (0.1 mV) deep and 0.08 seconds in duration, more than sufficient to meet the criteria of Morris et al. for left atrial enlargement. 1 In addition, Pwaves in lead II, aVF, and V 2 -V 6 are 0.12 seconds in duration 2 and bifid with >0.04 seconds between the two peaks 3 – the two defining features of P mitrale. Left atrial enlargement often is the initial, and may be the only, electrocardiographic manifestation of mitral stenosis. In addition, evidence of a systemic embolus, such as amaurosis fugax, in a young or middle-aged woman suggests mitral stenosis, even though its prevalence in the developed world has decreased strikingly over the last half century. This patient had moderately severe mitral stenosis with a valve area of 1.1 cm. 2 REFERENCES 1. Morris JJ Jr, Estes EH Jr, Whalen RE, et al. P-wave analysis in valvular heart disease. Circulation 1964;29:242-252. 2. Reynolds G. The atrial electrogram in mitral stenosis. Br Heart J 1953;15:250-258. 3. Thomas P, DeJong D. The P wave in the electrocardiogram in the diagnosis of heart disease. Br Heart J 1954;16:241-254. Dr. Glancy is a Professor and Dr. Abide is a Fellow in the Sections of Cardiology, Departments of Medicine, Louisiana State University Health Sciences Center and the Interim LSU Hospital, New Orleans.
J La State Med Soc VOL 166 January/February 2014 37
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