accessory mitral valve

Clinical History:A 30-year-old asymptomatic female is referred for transthoracic imaging as part of an evaluation of a family history of sudden cardiac death. Her examination is benign, she has no murmurs. The electrocardiogram is normal. Her ultrasound images are shown below.

A parasternal long axis image in mid-diastole demonstrating the left atrium (LA), left ventricle (LV) and a serpiginous membrane between the anterior and posterior mitral valve leaflet (arrows). Color flow examination and pulsed Doppler examination (not shown) failed to demonstrate either significant mitral regurgitation or stenosis

Unroofed coronary sinus

 

One of atrial septal defect types is Unroofed coronary sinus

what is mitral

The mitral valve. The mitral (left atrioventricular or bicuspid) valve is so named because of its resemblance to a cardinal’s hat, known as a mitre. Left: Photo of Pope John Paul II from
the Vatican web site

echo shows severe LV Hypertrophy , ECG is low voltage

echo shows severe LV Hypertrophy , ECG is low voltage

ECG of cardiac arrest

Two different cases of cardiac arrest

Is there ST elevation?

This 51 yo male complained of chest pain, then had a v fib arrest. He was resuscitated and brought to the ED where this ECG was recorded. He was in cardiogenic shock

There is tachycardia, and there is a wide complex. This wide complex tachycardia could easily be misdiagnosed as V tach. However, there are p-waves, and this is a classic RBBB + LAFB (left anterior fascicular block) morphology. When V tach originates in the left ventricle, there may be an RBBB-like complex, but because VT originates in the myocardium, not in the left bundle (as does RBBB), it does not look exactly like RBBB, as this one does. The left anterior fascicular block can be diagnosed by the left axis deviation. RBBB alone would have S-waves in I and aVL; since there are late large R-waves, there is LAFB.

So now we can say it is sinus tach with RBBB + LAFB

Is there ST elevation?

 

What is that ECG Diagnosis

A case with history of syncope