The final e is not silent. Broad, notched P waves in several or many leads of the electrocardiogram with a prominent late negative component to the P wave in lead V1, presumed to be characteristic of mitral valvular disease. (Although this term is extensively used in electrocardiographic literature, it is actually a misnomer and would be more appropriately called P-sinistrocardiale, as it results from overload of the left atrium regardless of the cause and may occur independently of disease of the mitral valve.)