Mitral regurgitation electrocardiogram


 * Associate Editor-In-Chief: Mohammed A. Sbeih, M.D.[mailto:msbeih@perfuse.org].

Overview
In severe cases of mitral regurgitation, left ventricular hypertrophy with strain; left atrial enlargement, and signs of pulmonary hypertension may be observed on the resting EKG. Chronic mitral regurgitation is associated with an increased risk for atrial fibrillation.

EKG Signs in Mitral Regurgitation
1. LA enlargement: Left atrial enlargement produces a broad, bifid P wave in lead II (P mitrale) and enlarges the terminal negative portion of the P wave in VI.

In lead II following may be seen:
 * Bifid P wave with > 40 ms between the two peaks
 * Total P wave duration > 110 ms

In lead V1, the following may be seen:
 * Biphasic P wave with terminal negative portion > 40 ms duration
 * Biphasic P wave with terminal negative portion > 1mm deep



2. Atrial fibrillation is commonly seen with mitral regurgitation: This is identified as an irregularly irregular rhythm with absence P waves.

Below is an ECG in mitral regurgitation. Note the evidence of left atrial enlargement in lead V1: