Introduction
Left atrial enlargement (LAE) may result from many conditions, either congenital or acquired.
As per echocardiography, using body surface area, an index LA volume is resulted, with a recommended upper limit of normal being an indexed left atrial volume of 34 mL per square meter.
Causes
Acquired
- mitral stenosis
- mitral regurgitation
- left ventricular failure
- left atrial myxoma
- atrial fibrillation
Congenital
- ventricular septal defect (VSD)
- patent ductus arteriosus (PDA)
Clinical presentation
- Ortner syndrome: left recurrent laryngeal nerve palsy secondary to compression from enlarged left atrium
- dysphagia megalatriensis: compression of esophagus between the enlarged left atrium and vertebral bodies
- atrial fibrillation
- thromboembolic events (e.g. ischemic stroke) due to stasis of blood in the enlarged left atrium (especially the left atrial appendage) and/or atrial fibrillation
ECG presentation
- broad, bifid P wave in lead II (P mitrale) and enlarges the terminal negative portion of the P wave in V1
In lead II
- bifid P wave with > 40 ms between the two peaks
- Total P wave duration > 110 ms
In lead V1
- Biphasic P wave with terminal negative portion > 40 ms duration
- Biphasic P wave with terminal negative portion > 1mm deep
Picture 1 P mitrale
Picture 2 Terminal negative portion of the P wave in V1
References
- Parajuli P, Ahmed AA. Left Atrial Enlargement. 2020 Aug 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 31971736.
- https://litfl.com/left-atrial-enlargement-ecg-library/
- https://radiopaedia.org/articles/left-atrial-enlargement
Introduction
Left atrial enlargement (LAE) may result from many conditions, either congenital or acquired.
As per echocardiography, using body surface area, an index LA volume is resulted, with a recommended upper limit of normal being an indexed left atrial volume of 34 mL per square meter.
Causes
Acquired
- mitral stenosis
- mitral regurgitation
- left ventricular failure
- left atrial myxoma
- atrial fibrillation
Congenital
- ventricular septal defect (VSD)
- patent ductus arteriosus (PDA)
Clinical presentation
- Ortner syndrome: left recurrent laryngeal nerve palsy secondary to compression from enlarged left atrium
- dysphagia megalatriensis: compression of esophagus between the enlarged left atrium and vertebral bodies
- atrial fibrillation
- thromboembolic events (e.g. ischemic stroke) due to stasis of blood in the enlarged left atrium (especially the left atrial appendage) and/or atrial fibrillation
ECG presentation
- broad, bifid P wave in lead II (P mitrale) and enlarges the terminal negative portion of the P wave in V1
In lead II
- bifid P wave with > 40 ms between the two peaks
- Total P wave duration > 110 ms
In lead V1
- Biphasic P wave with terminal negative portion > 40 ms duration
- Biphasic P wave with terminal negative portion > 1mm deep
Picture 1 P mitrale
Picture 2 Terminal negative portion of the P wave in V1
References
- Parajuli P, Ahmed AA. Left Atrial Enlargement. 2020 Aug 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 31971736.
- https://litfl.com/left-atrial-enlargement-ecg-library/
- https://radiopaedia.org/articles/left-atrial-enlargement
