Mitral Incompetence: LV Volume Overload
Report:
Sinus rhythm.
Left atrial abnormality
Normal axis.
Left ventricular hypertrophy with volume overload pattern.
Comment:
Tall prominent T waves and, later, merely upright ones, constitute the LV volume, or diastolic, overload pattern. It can only be diagnosed when other causes of tall T waves can be ruled out.
It is characteristic of mitral incompetence LVH to have a relatively small S wave in lead V1.
This patient had a long-standing systolic murmur and known mitral valve prolapse. Repeat echocardiogram on admission showed a flail posterior leaflet, obviously responsible for his admission in pulmonary œdema. The valve was repaired surgically.
An old teacher told us once that, if a man next to us on a bus suddenly goes into pulmonary œdema, he’s probably snapped a chord. I asked: “Why not an arrhythmia?” “It would take longer”, he said.
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