Echocardiographic manifestations of normal atrial contraction on the left ventricular posterior wall (LVPW), ventricular septum (VS), right ventricular anterior wall (RVAW), and the aortic root have not been described previously in detail. In 150 consecutive echocardiograms recorded from patients in normal sinus rhythm, we have been able to find correlates of normal atrial contraction (A waves) on the LVPW in 130, on the VS in 95, on the RVAW in 27, and on the aortic root in 107. These waves occurred on the aortic root 0.04 0.06 sec after the onset of the P wave, and they occurred on the other cardiac structures 0.06 0.10 sec after the onset of the P wave. That these waves were due to atrial contraction was established by their close temporal relationship to the P wave in normal and abnormal atrioventricular (AV) conduction and by their absence whenever the QRS complex was not preceded by a P wave. First-degree AV block was associated with “premature” mitral closure. Premature atrial contractions produced definite A waves on the aortic root, but less distinct waves on the other structures. These echocardiographic correlates of atrial contraction provide another noninvasive means of assessing the atrial contribution to ventricular filling. Echocardiographic study of ten patients in atrial flutter showed that atrial flutter contractions produced regular undulations on the mitral valve leaflets, tricuspid valve leaflets, left ventricular posterior wall, ventricular septum, aortic root and cusps, and the anterior and posterior left atrial wall. Echocardiographic observations made in 40 patients in atrial fibrillation frequently showed undulations on the mitral and tricuspid valves, aortic root, pulmonary valve cusp, and left atrial anterior wall. In some instances, the diastolic undulations on the mitral valve leaflets showed only minimal variations in amplitude and frequency even though the simultaneously recorded electrocardiogram showed marked irregularity of amplitude and frequency of atrial undulations.
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