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In six cases the mitral definitely preceded the aortic lesion ; these include the 4 cases of R.A.D. and 2 with
no deviation. In three both lesions were present when first seen ; two have a L.A.D. and the other none. In
one the aortic lesion probably preceded the mitral lesion ; this has no deviation.
B. P Waves.
All P waves normal 2
P 1 flat 4
P 2 + 1
P 2 flat or very small 5
P 3 3
P 3 inverted 1
All notched 1
P 1 and 2 notched 1
P 3 notched 1
In this group also, in one case only is a P wave enlarged, in three cases the P waves are notched.
C. Conduction.
P — R prolonged 3
D. Q.R.S. Wave.
R 1 notched 3
E. T Waves.
T 1 flat 1
T 2 and 3 + 1
Mitral Stenosis and Pericarditis.
A. Deviation.
L.A.D 2
R.A.D 1
The case of R.A.D. is the one which has aortic disease as well.
B. P Waves.
All normal 1
P 2 + 1
All flat 1
C. Conduction.
P — R + 2
P — R normal 1
D. Q.R.S. Wave.
R 1 notched 1
E. T Waves.
T 2 -4- 1
Control Cases. 35 cases with no murmur and no active carditis. Some have had a mild attack of
myocarditis.
A. Deviation.
No deviation 22
L.A.D 4
R.A.D 9
B. P Waves.
All P waves normal ... ... ... ... ... 12
P 2 + 1
P 1 flat or very small 6
P 2 „ „ 4
P 3 12
Inverted or biphasic 5
The small P 3 can hardly be described as abnormal.
C. Conduction.
P — R prolonged 5
D. Q.R.S. Wave.
Q.R.S. 1 notched ... ... ... ... ... 1
Q.R.S. 3 notched 2
(not abnormal)
E. T Waves.
T 1 flat or very small... ... ... 1
T 2 „ „ 2
T 3 2
T 3 inverted 3
Discussion.
In adult cases it is generally held that the electrocardiogram in patients with mitral stenosis is often
characteristic. There is, fairly commonly, R.A.D., and the P waves are either increased or abnormal in form.
It will be seen, however, that in the 35 children's cases analysed there is no such common change in deviation.
There is R.A.D. in 11 cases out of the 35, but it must be remembered that R.A.D. is not considered abnormal
in children, and in the control cases there are 9.
The P waves are enlarged or notched in 8 cases out of 35, whereas in the control cases only one case shows
enlargement. In two cases only, both R.A.D. and abnormal P waves occur together.
Conclusion.
There are no definite characteristic changes in the electrocardiograms of cases of mitral stenosis in children.
The only alteration that is found with any frequency is an enlarged or notched P wave. The control patients
show this change in 2 8 per cent, of the cases. The mitral stenosis patients show this change in 23 per cent, of
the cases; but where mitral stenosis is the only lesion, in 13 per cent, of the cases only. It would seem, therefore,
that an abnormal P wave is associated with cardiac lesions in children, but the difference between 2-8 per cent,
and 13 per cent., though suggestive, is not sufficient to indicate that abnormal P waves are characteristic of mitral
stenosis in children.