Mitral Stenosis
Report:
Sinus rhythm 99/min
Right axis deviation +125o
Late transition (clockwise rotation)
Left atrial abnormality
Small voltage in frontal leads
Comment:
The combination of LAA and presumptive RVH (from RAD and clockwise rotation) is suggestive of mitral stenosis. This patient had some mitral incompetence, but stenosis was the dominant lesion; hence the LV remained relatively small, allowing the RVH to be electrocardiographically manifest.
The LAA is, typically, quite marked, both as large PTF in V1 and classical, notched P mitrale (in L2 or V5).
As often happens, the postoperative (post-MVR, Fig 34a) trace was much less diagnostic; too many things happen at that time. The RAD went, but the R wave in V1 is now unequivocally dominant, with right precordial ST segment depression. Speaking of the RAD, the computer diagnosed it as LPHB in the original trace. This is a good example of why LPHB cannot be diagnosed on ECG grounds alone â it requires clinical exclusion of RVH.
34a. Post-MVR trace. 35. 20 year old man with chest pain
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