A New Sign of Left Ventricular Failure.

The prominent P wave associated with mitral stenosis is well recognized it is usually widened and is often notched, bifid, or flat-topped ; it is generally thought to be a result of left auricular hypertrophy. There is also some evidence that a tall spiked P wave may be produced by right auricular hypertrophy, for such a wave is rarely found except in cases of tricuspid stenosis," congenital pulmonary stenosis, and chronic cor pulmonale. It is the purpose of this communication to draw attention to a third type of P wave which we have found to be commonly associated with hypertensive heart disease, especially when there is left ventricular failure. This P wave is widened and of low voltage ; it is also usually bifid or flat-topped. Typical examples of these three types of P wave are shown in Figs. 1-3.