Mitral Stenosis

Report:

Sinus rhythm.

Left atrial abnormality (LAA.)

Probable right atrial enlargement.

Right axis deviation.

Probable right ventricular hypertrophy.

Prolonged QT interval.

Comment:

This is one of those ECGs that delight the reporter, making him feel like a spectator of ancient tragedy, aware of the dramatic irony unknown to the protagonists!

The marked LAA (P mitrale) in combination with small lead 1 complex and RAD, with normal left ventricular leads and QS or QR in V1, is almost pathognomonic of mitral stenosis.

The Q wave in anteroseptal leads may denote right atrial enlargement and be its sole sign in atrial fibrillation162.

The cause of QTc prolongation in this patient remains unknown. Quinidine, used to prevent atrial fibrillation, was the most likely suspect in those days (1993), but no data are available on this patient. She did have MS (we checked). If she saw a Cardiologist first she would have never – with bit of luck, and Warfarin – needed a Neurologist!

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