Electrocardiogram in a 28-Year-Old Woman with Dyspnea on Exertion
| Autor: | Lopez Fa, Glancy Dl |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
medicine.medical_specialty
Mitral regurgitation business.industry Diastole General Medicine medicine.disease Surgery Stenosis medicine.anatomical_structure Parasternal line Internal medicine Mitral valve cardiovascular system Cardiology Left atrial enlargement Medicine cardiovascular diseases Left Atrial Myxoma business Third heart sound |
| Zdroj: | Baylor University Medical Center Proceedings. 27:229-230 |
| ISSN: | 1525-3252 0899-8280 |
| Popis: | A28-year-old HIV-infected woman with dyspnea on exertion for 6 months had no history of acute rheumatic fever or opportunistic infections and no family history of heart disease. Her CD4 count 3 months earlier was 473/μL, and she was adherent with her antiretroviral therapy. On physical examination her neck veins were normal, as were her carotid pulses. The chest was clear to auscultation. A 1+/4+ left parasternal (right ventricular) lift was felt, and the left ventricular impulse was normal. The first heart sound was loud and split. The second heart sound was loud and palpable in the second left intercostal space. Heard at the cardiac apex were a soft pansystolic murmur of mitral regurgitation and an early low-medium pitched third heart sound immediately followed by a typical diastolic murmur of mitral stenosis. An electrocardiogram was normal except for signs of left atrial enlargement: a negative terminal portion of the P wave in lead V1 ≥ 0.1 mV in amplitude and ≥ 0.04 seconds in duration (2); P waves in leads II, III, aVF, V3, and V4 ≥ 0.12 seconds in duration (3); and bifid with >0.04 seconds between the 2 peaks (4) in leads III and V3 (Figure). Figure. Electrocardiogram in a 28-year-old woman with exertional dyspnea for 6 months. See text for explication. An echocardiogram explained how a patient with a third heart sound could have a typical murmur of mitral stenosis by demonstrating a large left atrial myxoma that fell into the mitral orifice early in each diastole causing a “tumor plop” followed by a mitral stenosis murmur because the orifice of the valve was almost completely occluded. The mean diastolic pressure gradient across the mitral valve was 18 mm Hg as measured by echo-Doppler. Because the hemodynamics of left atrial myxoma and mitral stenosis are so similar, it is not surprising that both the physical exam and the electrocardiogram would be similar in the two conditions, with P waves suggesting left atrial enlargement being early electrocardiographic findings in both. The patient underwent uneventful operative removal of a 5 × 4 × 8.5 cm left atrial myxoma. |
| Databáze: | OpenAIRE |
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