A Reverse Mitral A-Wave and a Late Systolic Tricuspid Regurgitation Jet due to Retrograde Atrial Activation

Figures

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  Figure 1. Twelve-lead ECG demonstrates retrograde P waves in alternate cycles (arrows) starting with the first QRS complex. Retrograde P waves are seen as negative deflections closely following the QRS complexes.

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  Figure 2. Transthoracic echocardiography, apical 4-chamber view with PW Doppler interrogation of mitral inflow, demonstrates an initial negative wave during systole (arrows) followed by the early diastolic E wave. The negative wave coincides with the retrograde P wave in the gated ECG. LV, Left ventricle.

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  Figure 3. Transthoracic echocardiography, apical 4-chamber view with CW Doppler interrogation across the MV, demonstrates mild MR. There is a superimposed flow (arrows) starting well after the initiation of MR corresponding to the retrograde P waves. LV, Left ventricle.

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  Figure 4. Transthoracic echocardiography, apical 4-chamber view with CW Doppler interrogation across the TV, demonstrates TR. There is a second TR jet (arrows) appearing with retrograde P waves. LV, Left ventricle.

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  Figure 5. Transthoracic echocardiography, apical 4-chamber view with CW Doppler interrogation across the TV, demonstrates TR. In the first cycle (single arrow), there is a second TR jet appearing with retrograde P wave, which is absent in the second cycle (double arrow), which is a sinus beat without retrograde P wave. LV, Left ventricle.