Mixed Mitral Valve Disease
Report:
Sinus rhythm 55/min
SVEB, LBBB aberrancy
Left atrial abnormality
Borderline right axis deviation +90o
Borderline low voltage in frontal leads
LVH voltage chest leads
Nonspecific ST/T changes
Comment:
The picture would be that of mitral stenosis, with small L1, rightward axis and marked LAA, real P mitrale, except for the unexpectedly large precordial voltages. They are due to associated mitral incompetence. The patient had a rheumatic “mixed mitral valve disease”. Note again the unexpectedly small SV1 and still upright T waves.
The SVEB is an atrial ectopic, with prolonged P’R interval and a coupling interval likely to trigger AF – less than half P-P interval. AF is also predicted by the marked LAA.
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