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By Request, P wave morphology and what it tells us!

by on March 12, 2011

P waves signify depolarization of the Atria. A normal P wave is uniform and upright and look the same, there also must be upright in leads II and AVF and Inverted in AVR for a rhythm to be considered Sinus rhythm.

We know from calls that we run that P waves can take several different shapes and sometimes are not even present or discernible. Here are some of the reason for P wave shapes and what they may signify.

  • Prolonged P wave > .20 may signify Left Atrial enlargement Left Atrial enlargement may also accompany mitral stenosis.
  • M shaped P wave (mitral stenosis) usually a tell tell sign of Left Atrial enlargement
  • Increased P wave amplitude can signify Hypokalemia
  • Press CTRL and + to magnify image

  • Increased P wave amplitude can also signify Right Atrial enlargement(RAE). RAE is characterized by a P wave height greater than 2.5 mm
  • Decreased P wave amplitude can signify Hyperkalemia
  • click on above image to magnify

  • absent P wave may indicate Atrial Fibrillation
  • Saw tooth form may indicate Atrial Flutter
  • This is just a few examples of P wave morphology changes.

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    From → Education, Requests

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