ECG findings in mitral stenosis

In mitral stenosis the ECG is often normal.
Pathological changes in the ECG include:
*.left atrial hypertrophy:
*.causes P mitrale
*.increased voltage in the later part of the P wave gives it a large, bifid appearance in leads II, III and aVF
*.the second half of the P wave is negative in V1
*.atrial fibrillation is present in 60 to 70%
*.right ventricular hypertrophy:
*.a dominant R wave in V1 and V2 indicates pulmonary hypertension
*.right axis deviation
*.there may be digitalis effects