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Patient
57- year-old man with familial hypertrophic cardiomyopathy;
Trace
Sinus rhythm with a major alteration of the P-wave pattern consistent with left atrial enlargement: broad P-wave > 140 ms, bifid P-wave in leads I, II, III, aVF and from V3 to V6, enlarged negative component in V1; a likely left ventricular hypertrophy with increased R wave voltages in aVL and V4 and in S wave voltage in V3, lateral repolarization disturbances;
Exergue
Left atrial enlargement is reflected on the ECG by an increase in the duration of the P-wave (> 110 ms) with a possible bifid pattern, a left axis deviation of the P-wave (< 15°), a positive Morris index (increase in duration > 40 ms and amplitude > 1 mm of the terminal negativity of the P-wave in V1).
In left atrial enlargement, the left atrial component of the P-wave is increased in terms of voltage and duration. Various abnormalities allow establishing a left atrial enlargement: