The document discusses findings from a 12-lead electrocardiogram and chest X-ray related to severe mitral stenosis and right ventricular hypertrophy. Key ECG findings include biatrial enlargement, peaked P waves, and prolonged P wave duration, which suggest both right and left atrial enlargement. X-ray findings confirm right ventricular hypertrophy and pulmonary artery hypertension.

1. ATRIAL ENLARGEMENT
12 LEAD ELECTROCARDIOGRAM

2. CHEST X-RAY PA
VIEW :CRHD
,SEVERE MITRAL
STENOSIS
,RVSP=84MMHG

3. X-RAY SHOWS
RVH
01
RAE
02
LAE
03
PAH
04
PVH
05

4. 12 LEAD ECG

5. FINDINGS ECG
RIGHT AXIS
DEVIATION OF
P WAVE
RIGHT AXIS
DEVIATION OF
QRS
BIATRIAL
ENLARGEMENT

6. RIGHT ATRIAL ENLARGEMENT
 Peaked P waves with amplitudes in lead II to >0.25 mV (“P pulmonale”)
 Prominent initial positivity in lead V 1 or V 2 >0.15 mv
 Increased area under initial positive portion of P wave in lead V 1 to
>0.06 mm-sec
 Rightward shift of mean P wave axis to
>+75 degrees

7. Left atrial enlargement
 Prolonged P wave duration to >120 msec in lead II
 Prominent notching of P wave, usually most obvious in lead II, with interval
between notches of >40 msec (“P mitrale”)
 Ratio between duration of P wave in lead II and duration of PR segment >1.6
 Increased duration and depth of terminal-negative portion of P wave in lead V
1 (P terminal force) so that area subtended by it >0.04 mm-sec
 Leftward shift of mean P wave axis to between −30 and −45 degrees

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