P mitrale

IIV1

LA abnormality.

P mitrale is notched and wide P wave in lead II. The two peaks should be apart > 0.04 sec. P wave in V1 frequently has left atrial abnormality pattern as well.

Patient. 51 year old female with the diagnosis of rheumatic mitral stenosis of moderate degree. Echocardiogram showed left atrial size of 6.5 cm, and mild pulmonary hypertension. She has recurrent atrial fibrillation.

P wave abnormalities. There are wide range of variation of P wave abnormalities since several factors may effect the P wave. These include: Anatomic cardiac position to the anterior chest wall, state of autonomic influence, intra and/or interatrial conduction abnormality, atrial pressure and/or volume load, atrial diseases, electrode positioning (precordial lead). The diagnostic sensitivity are poor.

LA abnormality, RA abnormality, or Intra/inter atrial conduction defect are better term than LA enlargement or RA enlargement.

LA abnormality

RA abnormality

• Prolonged P wave >120 ms (0.12 sec).
• Notched P wave in lead II ( P mitrale). The 2 peaks should be apart >0.04 sec.
• Terminal negative P wave in lead V1 area >0.04 (amplitude in mV x duration in second).
• Left shift of P wave axis on frontal plane (from +45 and +60 to -30 and +45)
• Peaked P wave in lead II (inferior leads) > 2.5 mV.
• Initial positive P wave in lead V1 amplitude >1.5 mV and area >0.06 (amplitude in mV x duration in second).
• Right shift of P wave axis on frontal plane (from +0 to +75 to more than + 75)

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IIV1
LA abnormality.
P mitrale is notched and wide P wave in lead II. The two peaks should be apart > 0.04 sec. P wave in V1 frequently has left atrial abnormality pattern as well.
Patient. 51 year old female with the diagnosis of rheumatic mitral stenosis of moderate degree. Echocardiogram showed left atrial size of 6.5 cm, and mild pulmonary hypertension. She has recurrent atrial fibrillation.
P wave abnormalities. There are wide range of variation of P wave abnormalities since several factors may effect the P wave. These include: Anatomic cardiac position to the anterior chest wall, state of autonomic influence, intra and/or interatrial conduction abnormality, atrial pressure and/or volume load, atrial diseases, electrode positioning (precordial lead). The diagnostic sensitivity are poor.
LA abnormality, RA abnormality, or Intra/inter atrial conduction defect are better term than LA enlargement or RA enlargement.
LA abnormality	RA abnormality
• Prolonged P wave >120 ms (0.12 sec). • Notched P wave in lead II ( P mitrale). The 2 peaks should be apart >0.04 sec. • Terminal negative P wave in lead V1 area >0.04 (amplitude in mV x duration in second). • Left shift of P wave axis on frontal plane (from +45 and +60 to -30 and +45)	• Peaked P wave in lead II (inferior leads) > 2.5 mV. • Initial positive P wave in lead V1 amplitude >1.5 mV and area >0.06 (amplitude in mV x duration in second). • Right shift of P wave axis on frontal plane (from +0 to +75 to more than + 75)