Left Atrial
Also written as LA.
CHA2DS2-VASc is at least 4 (age 65 to 74, female, hypertension, LV dysfunction), so anticoagulation is needed to prevent stroke from left atrial thrombus, and before and for 4 weeks after cardioversion.
What our notes say
- CHA2DS2-VASc is at least 4 (age 65 to 74, female, hypertension, LV dysfunction), so anticoagulation is needed to prevent stroke from left atrial thrombus, and before and for 4 weeks after cardioversion. (Clinical Pharmacology I (MBPL 4400) main exam: 25 January 2023)
- This elevated pressure is due to a combination of increased pulmonary vascular resistance (PVR), increased pulmonary blood flow, and/or increased left atrial pressure. (Pulmonary hypertension and cor pulmonale)
- Rheumatic inflammation → fibrosis & commissural fusion → narrowed orifice → ↑ left‑atrial pressure → atrial dilation → atrial fibrillation → pulmonary hypertension → right‑heart strain. (Heart murmurs)
- Rheumatic inflammation leads to leaflet thickening, commissural fusion, and chordal shortening, producing a narrowed orifice that raises left‑atrial pressure and generates the characteristic opening snap and diastolic rumble. (Heart murmurs)
- LV diastolic compliance – collagen matrix, titin elasticity, relaxation‐dependent calcium re‑uptake: Impaired relaxation raises left‑atrial pressure → dyspnoea on exertion, PND; examiner will ask about “preserved EF but high LVEDP”. (Heart failure: which tests and why)
- Elevated left‑atrial pressure → pulmonary venous congestion → dyspnoea, rales (Heart failure: which tests and why)
Study material on Left Atrial
- Harrisons Cardiovascular Medicine 2nd Edition 2
- Davidson's Essentials of Medicine - 2nd
- Harrisons Pulmonary and Critical Care Medicine
- Valvular Heart Disease
- CVS History & Physical Exam: Symptoms, Chest Pain & Syncope — Notes
- Heart murmurs
- CARDIOVASCULAR PATHOLOGY
- Pulmonary hypertension and cor pulmonale
- ECG MADE EASY (1)
- ECG MADE EASY (1)
Practice questions on Left Atrial
A 45-year-old woman has orthopnea, dysphagia, and a prior stroke. CXR shows near-normal LV but prominent left atrial border. Most likely condition?
- Mitral stenosis
- Aortic regurgitation
- Mitral regurgitation
- Tricuspid regurgitation
Answer: A. Orthopnea and a prominent left atrial border on CXR in the setting of dysphagia and prior stroke suggest a significant left atrial abnormality, most commonly caused by mitral stenosis. Mitral stenosis leads to left atrial enlargement due to increased pressure and volume backup from the left atrium into the left ventricle. Dysphagia can be due to compression of the esophagus by an enlarged left atrium. Prior stroke ma