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The P wave
Published in Andrew R Houghton, Making Sense of the ECG, 2019
The P wave becomes broad because the enlarged left atrium takes longer than normal to depolarize. As with P pulmonale, P mitrale does not require treatment in its own right, but should alert you to a possible underlying problem. This is often mitral valve disease, but left atrial enlargement can also accompany left ventricular hypertrophy (e.g. secondary to hypertension, aortic valve disease and hypertrophic cardiomyopathy). A chest X-ray and an echocardiogram may be helpful following a patient history and examination.
Cardiology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
ECG may show right atrial enlargement, left ventricular hypertrophy and left axis deviation. Left ventricular hypertrophy may be visualised on CXR and pulmonary markings depend on the haemodynamics caused by the associated lesions.
The P wave
Published in Andrew R Houghton, David Gray, Making Sense of the ECG, 2014
The P wave becomes broad because the enlarged left atrium takes longer than normal to depolarize. As with P pulmonale, P mitrale does not require treatment in its own right, but should alert you to a possible underlying problem. This is often mitral valve disease, but left atrial enlargement can also accompany left ventricular hypertrophy (e.g. secondary to hypertension, aortic valve disease and hypertrophic cardiomyopathy). A chest X-ray and an echocardiogram may be helpful following a patient history and examination.
Advanced interatrial block predicts ineffective cardioversion of atrial fibrillation: a FinCV2 cohort study
Published in Annals of Medicine, 2021
Arto Relander, Tapio Hellman, Tuija Vasankari, Ilpo Nuotio, Juhani K. E. Airaksinen, Tuomas Kiviniemi
Elective CVs were performed by an attending internist or cardiologist under general anaesthesia according to the current guidelines. ECGs were recorded and interpreted by the clinician prior to and after the procedure to confirm AF and determine the CV outcome, respectively. The CV energy and positioning of the defibrillator paddles (anterolateral or anteroposterior configuration) were left to the discretion of the attending clinician. Data on CV energy and defibrillator positioning is unavailable. CVs were performed using biphasic defibrillators after 2004. Transesophageal echocardiograms were not routinely performed if anticoagulating agents were used as prescribed for at least 3 weeks. Previous transthoracic echocardiogram data was available on 218 (30.5%) cases. Left atrium diameter measurements were collected. Mild left atrial enlargement was defined as diameters > 41 mm in males and >39 mm in females, moderate enlargement as diameters >47 mm and >43 mm, respectively.
Influence of relative wall thickness on electrocardiographic voltage measures in left ventricular hypertrophy: a novel factor contributing to poor diagnostic accuracy
Published in Postgraduate Medicine, 2020
Ning Ye, Guo-Zhe Sun, Ying Zhou, Shao-Jun Wu, Ying-Xian Sun
A recent study [8] demonstrated that isolated left atrial dilation has indeterminately moderate effects on P-wave duration and voltage. In contrast, left atrial concentric hypertrophy consistently increased P-wave amplitude, with duration unaffected. These findings provided a potential explanation regarding the limited utility of current P-wave criteria in the detection and diagnosis of left atrial enlargement in clinical practice. However, insufficient data have been reported in relation to the independent influence of left ventricular geometry on ECG voltage for ascertaining LVH. A general consensus has been established regarding the use of echocardiographic relative wall thickness (RWT) when defining concentric and eccentric changes [9]. Hence, we subsequently proposed an original hypothesis suggesting that RWT itself could potentially influence the diagnostic performance of ECG indices by affecting QRS voltages, independent of the left ventricular mass index (LVMI). The influence of RWT on Cornell, Sokolow-Lyon and Peguero-Lo Presti voltage were examined, after which the effects identified were evaluated in regard to the diagnostic performance in detecting LVH in a large general Chinese population.
Left atrial volume index is superior to left atrial diameter index in relation to coronary heart disease in hypertension patients with preserved left ventricular ejection fraction
Published in Clinical and Experimental Hypertension, 2020
Ming Fu, Dan Zhou, Songtao Tang, Yingling Zhou, Yingqing Feng, Qingshan Geng
Because left atrial enlargement is an independent predictor of cardiovascular events, the accurate detection of this phenotype may improve the evaluation of risk in hypertensive patients. The prevalence of left atrial enlargement varied consistently among studies at rates of 16.0–83.0% (13). According to criteria based on the criterion of LA volume, the prevalence of left atrial enlargement was 17% in our study. In the previous study left atrial size and left atrial enlargement was related to LVM rather than the type of LVH (2). Our study shows Age, LVMI, and diastolic dysfunction parameter were positively correlated with left atrial size, consistent with the previous study (20,21). Patients with left ventricular hypertrophy had higher LAD and LAV. In our study, after adjusted LVMI, LAVI remain independent for CHD. LAV evaluation in hypertensive population can contribute to the identification of early cardiac damage or risk stratification other than the conventionally evaluated terms (LVH and LVMI).