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Amaurosis fugax in a 45-year-old woman.

DIAGNOSIS: Normal sinus rhythm; left atrial enlargement.

The negative component of the P wave in lead [V.sub.1] is 1 mm (0.1 mV) deep and 0.08 seconds in duration, more than sufficient to meet the criteria of Morris et al. for left atrial enlargement. (1) In addition, P waves in lead II, aVF, and [V.sub.2]-[V.sub.6] are 0.12 seconds in duration (2) and bifid with [greater than or equal to] 0.04 seconds between the two peaks (3)-the two defining features of P mitrale.

Left atrial enlargement often is the initial, and may be the only, electrocardiographic manifestation of mitral stenosis. In addition, evidence of a systemic embolus, such as amaurosis fugax, in a young or middle-aged woman suggests mitral stenosis, even though its prevalence in the developed world has decreased strikingly over the last half century. This patient had moderately severe mitral stenosis with a valve area of 1.1 [cm..sup.2]


(1.) Morris JJ Jr, Estes EH Jr, Whalen RE, et al. P-wave analysis in valvular heart disease. Circulation 1964;29:242-252.

(2.) Reynolds G. The atrial electrogram in mitral stenosis. Br Heart J 1953;15:250-258.

(3.) Thomas P, DeJong D. The P wave in the electrocardiogram in the diagnosis of heart disease. Br Heart J 1954;16:241-254.

D. Luke Glancy, MD; William P. Abide Jr., MD

Dr. Glancy is a Professor and Dr. Abide is a Fellow in the Sections of Cardiology, Departments of Medicine, Louisiana State University Health Sciences Center and the Interim LSU Hospital, New Orleans.

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Title Annotation:ECG of the Month
Author:Glancy, D. Luke; Abide, William P., Jr.
Publication:The Journal of the Louisiana State Medical Society
Article Type:Case study
Date:Jan 1, 2014
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