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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