Mitral Stenosis?
Report:
Sinus rhythm
Left atrial abnormality
P axis –30o
Right axis deviation +120o
Incomplete right bundle branch block
QRS 0.10”
Comment:
The trace suggests mitral stenosis. The LAA (true P mitrale in this case) is marked, both as increased P-terminal force in V1 and as 0.10” notched P wave in some other lead (lead 1 here). The RAD is a sign of RVH, secondary to pulmonary hypertension.
The diagnosis was quite different. The patient had a VSD repair in childhood and required no cardiac treatment since. She had Spitzen’s syndrome, with retardation. The case is similar to Case 143; there’s nothing specific for mitral stenosis.
Lead 2 illustrates one of its major disadvantages as a monitoring lead: there is hardly any visible atrial deflection there. This is because of the leftward shift of the P axis in LA enlargement and the fact that 2 = 1+3 algebraically. At –30o, the overall P vector in lead 2 is zero.
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