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ECG changes in mitral stenosis

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In mitral stenosis the ECG is often normal.

Pathological changes in the ECG include:

  • left atrial hypertrophy:
    • causes P mitrale
    • increased voltage in the later part of the P wave gives it a large, bifid appearance in leads II, III and aVF
    • the second half of the P wave is negative in V1

  • atrial fibrillation is present in 60 to 70%

  • right ventricular hypertrophy:
    • a dominant R wave in V1 and V2 indicates pulmonary hypertension

  • right axis deviation

  • there may be digitalis effects

Click for more detailed information and ECG examples

Last edited 06/2020

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