Printer Friendly

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]

REFERENCES

(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.

COPYRIGHT 2014 Louisiana State Medical Society
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2014 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
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
Words:264
Previous Article:Protecting the private practice of medicine: Louisiana's first physician-owned accountable care organization: the Inaugural 90 days.
Next Article:Progressive slurring of speech and difficulty reading in a 62-year-old male.
Topics:

Terms of use | Privacy policy | Copyright © 2019 Farlex, Inc. | Feedback | For webmasters