Mitral valve m-mode echo in complete heart block with atrial tachycardia

Kalathingathodika Sajeer; Deepak Raju; Babu Kanjirakadavath; Mangalachulli Pottammal Ranjith; Mangalath Narayanan Krishnan

doi:10.4103/2321-449x.122783

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CASE REPORT

Year : 2013 | Volume : 1 | Issue : 3 | Page : 83-84

Mitral valve m-mode echo in complete heart block with atrial tachycardia

Kalathingathodika Sajeer, Deepak Raju, Babu Kanjirakadavath, Mangalachulli Pottammal Ranjith, Mangalath Narayanan Krishnan
Department of Cardiology, Government Medical College, Kozhikode, Kerala, India

Date of Web Publication

7-Dec-2013

Correspondence Address:
Kalathingathodika Sajeer
Department of Cardiology, Govt. Medical College, Kozhikode - 673 008, Kerala
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/2321-449x.122783

Abstract

We report a 48-year-old man who presented with history of syncope. Electrocardiogram on admission showed infrahisian complete heart block with a ventricular rate of 36 beats per min with wide QRS junctional escape and atrial rate was 188 beats per min. Transthoracic echocardiogram showed fine vibratory movement of both mitral leaflet tips. M-mode evaluation of mitral leaflets showed multiple 'a' waves corresponding to atrial tachycardia rate.

Keywords: Atrial tachycardia, complete heart block, mitral valve, M-mode echocardiogram

How to cite this article:
Sajeer K, Raju D, Kanjirakadavath B, Ranjith MP, Krishnan MN. Mitral valve m-mode echo in complete heart block with atrial tachycardia. Heart India 2013;1:83-4

How to cite this URL:
Sajeer K, Raju D, Kanjirakadavath B, Ranjith MP, Krishnan MN. Mitral valve m-mode echo in complete heart block with atrial tachycardia. Heart India [serial online] 2013 [cited 2023 May 31];1:83-4. Available from: https://www.heartindia.net/text.asp?2013/1/3/83/122783

Case Report

A 48-year-old man presented with history of few episodes of syncope. His electrocardiogram at the time of admission showed infrahisian complete heart block with wide QRS (160 ms) junctional escape. The ventricular rate was 36 beats per min and there was atrial tachycardia at the rate of 188 beats per min [Figure 1]. A permanent pacemaker implantation was planned. Transthoracic echocardiogram was done to rule out any structural heart disease. Two dimensional (2D) echo imaging showed characteristic fine vibratory movement of anterior and posterior mitral leaflet tips. M-mode echo evaluation in parasternal long axis showed normal chamber dimensions of left atrium, left ventricle, and right ventricle. Anterior and posterior mitral leaflets on M-mode exhibited multiple 'a' waves corresponding to atrial tachycardia rate [Figure 2].

Figure 1: Electrocardiogram showing complete heart block with a heart rate of 36 beats per min with wide QRS (160 ms) junctional escape and atrial rate of 188 beats per min

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Figure 2: M-mode echo (parasternal long axis view) showing multiple 'a' waves on both anterior and posterior mitral leaflets corresponding to atrial tachycardia rate. RV = Right ventricle, IVS = interventricular septum, LV = left ventricle, PW = posterior wall, AML = anterior mitral leaflet, PML = posterior mitral leaflet, BPM = beats per min

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M-mode technique involves aligning the M-mode cursor through the mitral valve leaflets, atrial or ventricular walls and it permits visualization of the relationship between atrial and ventricular contractions. The role of M-mode echo in assessment of arrhythmia is limited in adults. But this technique is very useful in assessment of fetal cardiac arrhythmias. Semilunar and atrioventricular valve opening and closing points, 'a' waves and ventricular wall motion can be used for timing purposes and helps in the determination of heart rate and rhythm. ^[1],[2]

References

1.	Allan LD, Anderson RH, Sullivan ID, Campbell S, Holt DW, Tynan M. Evaluation of fetal arrhythmias by echocardiography. Br Heart J 1983;50:240-5. [PUBMED]
2.	Kleinman CS, Donnerstein RL, Jaffe CC, DeVore GR, Weinstein EM, Lynch DC, et al. Fetal echocardiography. A tool for evaluation of in utero cardiac arrhythmias and monitoring of in utero therapy: Analysis of 71 patients. Am J Cardiol 1983;51:237-43. [PUBMED]