To Detect Left Atrial Enlargment in Patient with Rheumatic Mitral Stenosis with Electrocardiography and It’s Corelation with Transthrasic 2D Echocardiography

Title: To Detect Left Atrial Enlargment in Patient with Rheumatic Mitral Stenosis with Electrocardiography and It’s Corelation with Transthrasic 2D Echocardiography

Authors: Dr Swanand Lunge, Dr Anil Modak, Dr Shalikram Jadhav

DOI: https://dx.doi.org/10.18535/jmscr/v5i3.56

Abstract

Introduction: Rheumatic heart disease is still common heart disease in India accounting for about 40% of total hospitalized cardiac cases in India and is most common cause of cardiac morbidity and mortality in the country. Mitral valve is most commonly affected, mitral stenosis (MS) being the most common manifestation. Female patients are more affected as compared to male patients.

Aims and Objectives: To correlate Electrocardiography (ECG) and 2D ECHO cardiography in detecting left atrial enlargement (LAE) in rheumatic mitral stenosis (RMS).

Material and Methods: The present study was a hospital based cross sectional study carried out from August 2014 to May 2015 at a tertiary care teaching hospital of central India. A total of 70 cases of RMS who came to Medicine department were enrolled in the study.

Observations: Out of 70 patients 30 were male and 40 females majority being in the age group <30 years. Severe mitral stenosis was found in 44.3% of the patients and that too, more in females as compared to males. On ECG, P-mitrale (ECG criteria for LA abnormality) was most common finding, found in 36.3% patients. 41.4% of patients showed LAE on 2D ECHO.

Conclusion: Currently 2D ECHO is used for diagnosis left atrial enlargement in RMS, which although considered more efficacious is costly and time consuming. The findings of present study suggests that ECG can detect LAE in RMS with nearly same efficacy as that of 2D ECHO with added advantage of being less costly and less time consuming.

Keywords: Electrocardiography, 2D echocardiography, Left atrial enlargement.

References

1. Sanyal SK, Thapar MK, Ahmed SH et al. The initial attack of acute rheumatic fever during childhood in North India: a prospective study of clinical profile. Circulation. 1974;49(1):7-12.

2. Carapetis JR, McDonald M, Wilson NJ. Acute rheumatic fever. Lancet. 2005:366(9480):155-68.

3. WHO:Rheumatic fever and rheumatic heart disease. Avialble from http://www.who.int/cardiovascular_diseases/publications/trs923/en/ last assessed on 30 Dec 2015.

4. Kumar RK, Tandon R. Rheumatic fever and rheumatic heart disease: the last 50 years. Indian J Med Res 2013:137(4):643-58.

5. Bonow RO, Carabello BA, Chatterjee K, et al. Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines.Circulation. 2008;118:e523-e661.

6. Manjunath C. Valvular heart disease. In: Munjal YP, Sharma SK, Agrawal A et al editors. API textbook of Medicine. 9th ed. Mumbai: Jaypee brothers Medical Publisher;2012:637-39.

7. O’Gara P, Loscalzo J. Valvular Heart Disease. In: Longo DL, Fauci AS, Kasper DL et al, editors. Harrison’s Principles of Internal Medicine. 18th ed. McGraw Hill Medical;2012:1929-33.

8. Patel DA, Lavie CJ, Milani RV, et al. Clinical implications of left atrial enlargement :a review. The Oschner Journal. 2009;9(14):191-6.

9. Otto CM, Bonow RO. Valvular Heart Disease. In: onow RO, Mann DL, Zipes DP, et al, editors. Braunwald’s Heart Disease Text of Cardiovascular Medicine. 9th ed. Philadelphia: Elsevier Saunders;2012:1490-9.

10. Kasper DL, FauciAS.. Mitral Valve Disease. In: Patrick T. O’Gara, Joseph Loscalzo editors. Harrison’s principles of internal medicine. 19th ed. McGraw Hill Medical NewYork;2015:1539-40.

11. Josephson ME, Kastor JA, Morganroth J. Electrocardiographic Left Atrial Enlarge-ment: Electrophysiologic, Echocardio-graphic and Hemodynamic correlates. Am J Cardiol1977; 39: 967–971.

12. Maok J, Krongrad E. Assessment of electrocardiographic criteria for left atrial enlargement in childhood. Am J Cardiol1984; 53: 215–217.

13. Munuswamy K, Alpert MA, Martin RH. Sensitivity and specificity of commonly used electrocardiographic criteria for left atrial enlargement determined by M-mode echocardiogtaphy. Am J Cardiol1984; 53: 829–832.

14. Mishra A, Mishra C, Mohanty RR, et al. Study on the diagnostic accuracy of left atrial enlargement by resting electrocardio-graphy and its echocardiographic correlation. Indian J PhysiolPharmacol.2008;52(1):31-42.

15. Kasper DL, Braunwald E, Fauci AS, et al. Harrison’s Principles of Internal Medicine, 16thedn., McGraw-Hill Medical Publishing Division 1390–1391.

16. Acquired Mitral Stenosis. Available from http://emedicine.medscape.com/article/902351-overview. Last assessed on 29 Dec 2014.

17. Hasan-Ali H, Shams-Eddin H, Abd-Elsayed AA, et al. Echocardiographic assessment of mitral valve morphology after Percutaneous Transvenous Mitral Commissurotomy (PTMC). Cardiovasc Ultrasound. 2007;5:48.

18. Cannan CR, Nishimura RA, Reeder GS, et al. Echocardiographic assessment of commissural calcium: a simple predictor of outcome after percutaneous mitral balloon valvotomy. J Am CollCardiol. 1997;29(1):175-80.

19. Hazen MS, Marwick TH, Underwood DA. Diagnostic accuracy of the resting electrocardiogram in detection and estimation of left atrial enlargement: An echocardiographic correlation in 551 patients. Am Heart J1991; 122: 823–828.

20. Manyari D, Patterson C, Johnson D et al. Atrial and ventricular arrhythmias in asymptomatic active elderly subjects: Correlation with left ventricular size and left ventricular mass. Am Heart J1990; 119: 1069–1076.

21. DiBianco R, Gottdiener JS, Fletcher RD. et al. Left atrial overload: a hemodynamic, echocardiographic, electrocardiographic and vectorcardiographic study. Am Heart J1979; 98:478–489.

22. Probst P, Hunber J, Gamble O. et al. Investigation of atrial aberration as a cause of altered P wave contour. Am Heart J1973; 86: 516–522.

23. Waggoner AD, Adyanthaya AV, Miguel MD, et al. Left atrial enlargement. Echoca-rdiographic assessment of electrocardio-graphic criteria. Circulaton. 1976;54:553-7.

24. Maganti J, Rigolin VH, Sarano ME, et al. Valvular heart disease: diagnosis and man-agement. Mayo Clin Proc. 2010;85(5):483-500.

25. Soloff LA, Zatuchni J. Relationships of the P wave to left atrial volume in rheumatic heart disease with mitral stenosis. Am J of Med Sci1958; 235: 290–296.

26. Kasser I, Kennedy JW. The relationship of increased left atrial volume and pressure to abnormal P-waves on the electrocardiogram. Circulation1969; 39: 339–343.

27. Hirata T, Wolfe SB, Popp RL et al. Estimatioof left atrial size using ultrasound. Am Heart J1969; 78: 43–52.

Abstract

References

Corresponding Author

Call For Paper Volume 12 Issue 12 December 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles

Search

Abstract

Call For Paper Volume 12 Issue 12 December 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles