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P Mitrale (Left Atrial Enlargement)

P sinistrocardiale, Left atrial enlargement, Left atrial abnormality, Delay of left atrial activation, Left atrial dilatation, Left atrial distention, Left atrial overload

Physiological P Wave

Schematic representation of the atria, P wave depolarization vectors

Mitral Stenosis and Left Atrial Abnormalities

Left atrial pressure overload and left atrial hypertrophy

P Mitrale and Atrial Vector

Left atrial hypertrophy electrical vector and P mitrale
  • Mitral Stenosis
    • Is the most common cause of left atrial remodeling
  • The left atrium is enlarged
    • Thus, the left atrial vector (P2) will also be enlarged
  • Enlarged Atrium
    • Regardless of the etiology (stenosis, regurgitation, myxoma)
    • It creates a larger vector (P2)
  • On the EKG, the pattern of P mitrale appears
    • P mitrale, because the most common cause is mitral stenosis
    • However, the EKG does not differentiate the etiology of "atrial enlargement"

P Mitrale and Lead II

P mitrale (wide and notched p wave) in frontal plane lead II

P Mitrale and Lead II


P Mitrale and Lead V1

P mitrale (biphasic p wave with terminal negative portion) in horizontal plane lead V1

P Mitrale and Lead V1

  • Lead V1 "views" the atrial vectors in the horizontal plane
  • The atria depolarize gradually:
    • First, the right atrium (P1 points towards V1) depolarizes
    • Then, the left atrium (P2 points away from V1) depolarizes
  • In P mitrale, the depolarization of the left atrium lasts longer and the vector points away from V1
    • The P wave will be biphasic in V1
    • and the second part will be deep (a more pronounced P2 vector points away from V1)

ECG and P Mitrale

ECG P Mitrale wide 120ms ECG P Mitrale terminal negative portion

Normal P Wave and P Mitrale

Normal heart atrial size
ECG lead II P wave with normal atrial size

ECG lead V1 P wave with normal atrial size

Normal P Wave

  • With a normal P wave, the atria are not enlarged
  • Leads II and V1 are assessed


P mitrale vs. normal P wave
ecg p mitrale wide 120ms

evg p mitrale terminal negative portion

P Mitrale




ECG p mitrale in lead II (bifid P wave) and lead V1 (biphasic P wave)

P Mitrale

  • Lead II
    • Double-peaked P wave (M)
      • Distance between peaks > 40ms
    • Width of the P wave > 110ms
  • Lead V1
    • Terminal negative portion is deep > 1mm
    • Area of the terminal portion > 1 small square
    • Width of the terminal negative deflection > 40ms


ECG p mitrale and left atrial hypertrophy in lead II (bifid P wave) and lead V1 (biphasic P wave)

P Mitrale




ECG p mitrale and left atrial abnormality in lead II (bifid P wave)

P Mitrale

  • In the ECG lead II
  • Double-peaked P wave (M)
  • The P wave is wider than 110ms
  • Distance between peaks is > 40ms

ECG P Mitrale and left atrial dilatation in lead V1 (biphasic P wave)

P Mitrale

  • In the ECG lead V1
  • Biphasic P wave
  • Terminal portion of the P wave is > 40ms
  • The terminal portion is not deeper than 1mm
  • Area of the terminal portion < 1 small square
    • But if other criteria are met in lead II, it is P Mitrale


12 lead ECG and P mitrale

P Mitrale




Sources

  • ECG from Basics to Essentials Step by Step
  • litfl.com
  • ecgwaves.com
  • metealpaslan.com
  • medmastery.com
  • uptodate.com
  • ecgpedia.org
  • wikipedia.org
  • Strong Medicine
  • Understanding Pacemakers





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Home /

P Mitrale (Left Atrial Enlargement)

P sinistrocardiale, Left atrial enlargement, Left atrial abnormality, Delay of left atrial activation, Left atrial dilatation, Left atrial distention, Left atrial overload

Physiological P Wave

Schematic representation of the atria, P wave depolarization vectors

Mitral Stenosis and Left Atrial Abnormalities

  • Mitral Stenosis
    • Causes pressure overload of the left atrium
    • The left atrium pumps blood through a stenotic (narrowed) mitral valve
    • Results in atrial hypertrophy
  • Mitral Regurgitation
    • Causes volume overload of the left atrium
    • The mitral valve is insufficient
      • During left ventricular systole, blood regurgitates into the left atrium
    • Results in volume overload and atrial dilation
  • Atrial hypertrophy and dilation can occur simultaneously
  • Atrial Myxoma
    • A myxoma is a benign tumor of connective tissue
    • It very commonly occurs in the atria of the heart
 Left atrial pressure overload and left atrial hypertrophy

P Mitrale and Atrial Vector

  • Mitral Stenosis
    • Is the most common cause of left atrial remodeling
  • The left atrium is enlarged
    • Thus, the left atrial vector (P2) will also be enlarged
  • Enlarged Atrium
    • Regardless of the etiology (stenosis, regurgitation, myxoma)
    • It creates a larger vector (P2)
  • On the EKG, the pattern of P mitrale appears
    • P mitrale, because the most common cause is mitral stenosis
    • However, the EKG does not differentiate the etiology of "atrial enlargement"
Left atrial hypertrophy electrical vector and P mitrale

P Mitrale and Lead II

P mitrale (wide and notched p wave) in frontal plane lead II

P Mitrale and Lead II


P Mitrale and Lead V1

P mitrale (biphasic p wave with terminal negative portion) in horizontal plane lead V1

P Mitrale and Lead V1

  • Lead V1 "views" the atrial vectors in the horizontal plane
  • The atria depolarize gradually:
    • First, the right atrium (P1 points towards V1) depolarizes
    • Then, the left atrium (P2 points away from V1) depolarizes
  • In P mitrale, the depolarization of the left atrium lasts longer and the vector points away from V1
    • The P wave will be biphasic in V1
    • and the second part will be deep (a more pronounced P2 vector points away from V1)

ECG and P Mitrale

  • Enlarged Left Atrium
    • Regardless of the etiology (Hypertrophy, Dilation, Myxoma)
    • Creates the pattern of P Mitrale
  • The P wave is assessed in leads II and V1
    • Because they "view" the atria from the best angle

  • Lead II (P Mitrale)
    • Double-peaked P wave (resembling the letter M), distance between peaks > 40ms
    • P wave width > 120ms
    • This specific "double-peaked" P wave in lead II is referred to as P Mitrale

  • Lead V1 (P Mitrale)
    • Terminal negative portion is deep > 1mm
    • Area of the terminal part > 1 small square
    • Width of the terminal negative portion > 40ms
ECG P Mitrale wide 120ms

ECG P Mitrale terminal negative portion

Normal P Wave and P Mitrale

Normal heart atrial size ECG lead II P wave with normal atrial size ECG lead V1 P wave with normal atrial size

Normal P Wave

  • With a normal P wave, the atria are not enlarged
  • Leads II and V1 are assessed


P mitrale vs. normal P wave ecg p mitrale wide 120ms evg p mitrale terminal negative portion

P Mitrale




ECG p mitrale in lead II (bifid P wave) and lead V1 (biphasic P wave)

P Mitrale

  • Lead II
    • Double-peaked P wave (M)
      • Distance between peaks > 40ms
    • Width of the P wave > 110ms
  • Lead V1
    • Terminal negative portion is deep > 1mm
    • Area of the terminal portion > 1 small square
    • Width of the terminal negative deflection > 40ms


ECG p mitrale and left atrial hypertrophy in lead II (bifid P wave) and lead V1 (biphasic P wave)

P Mitrale




ECG p mitrale and left atrial abnormality in lead II (bifid P wave)

P Mitrale

  • In the ECG lead II
  • Double-peaked P wave (M)
  • The P wave is wider than 110ms
  • Distance between peaks is > 40ms

ECG P Mitrale and left atrial dilatation in lead V1 (biphasic P wave)

P Mitrale

  • In the ECG lead V1
  • Biphasic P wave
  • Terminal portion of the P wave is > 40ms
  • The terminal portion is not deeper than 1mm
  • Area of the terminal portion < 1 small square
    • But if other criteria are met in lead II, it is P Mitrale


12 lead ECG and P mitrale

P Mitrale




Sources

  • ECG from Basics to Essentials Step by Step
  • litfl.com
  • ecgwaves.com
  • metealpaslan.com
  • medmastery.com
  • uptodate.com
  • ecgpedia.org
  • wikipedia.org
  • Strong Medicine
  • Understanding Pacemakers