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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