II. Findings: Normal

  1. Upright: I, II, avF, V4, V5, V6
  2. Inverted: aVR
  3. Variable: III, avL, V1, V2, V3

III. Causes: P Wave Inversion (other than aVR)

  1. Ectopic atrial focus
  2. AV nodal rhythm

IV. Causes: High Amplitude - Atrial hypertrophy or atrial dilatation

  1. Mitral valve or tricuspid valve disease
  2. Hypertension
  3. Cor Pulmonale
  4. Congenital Heart Disease

V. Causes: Low Amplitude (short P Wave)

  1. Hyperkalemia (associated with a tall T Wave)

VI. Causes: Wide P Wave (over .11 sec)

  1. Left atrial enlargement

VII. Causes: Biphasic P Wave (second half negative in III or V1)

  1. Left Atrial Enlargement

VIII. Causes: M shaped or notched P Wave

  1. M-Mitral or P-Mitrale: Left atrial enlargement
  2. Findings
    1. Over 0.04 seconds between peaks
    2. Taller in I than in III

IX. Causes: Peaked P Wave

  1. P-Pulmonale: Right atrial enlargement
  2. Findings
    1. Tall and pointed P Wave >2.5 mm in the inferior leads
    2. P Wave is taller in Lead III than in I

X. Causes: P Waves absent

  1. Precaution
    1. Look closely for regularly spaced "artifact" on the ekg (e.g. low voltage P Waves)
  2. Atrial Fibrillation or Atrial Flutter
  3. Sinoatrial node block
  4. AV Nodal rhythm

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: P pulmonale by EKG (finding) (C0232308)

Definition (NCI_CDISC) An electrocardiographic finding suggesting underlying hypertrophy or dilatation of the right atrium. Electrocardiographic criteria used for the diagnosis of right atrial abnormality may include a peaked p wave greater than 2.5 millimeters in amplitude in the inferior leads. (NCI)
Definition (NCI) An electrocardiographic finding suggesting underlying hypertrophy or dilatation of the right atrium. Electrocardiographic criteria used for the diagnosis of right atrial abnormality may include a peaked p wave greater than 2.5 millimeters in amplitude in the inferior leads.
Concepts Finding (T033)
SnomedCT 142074002, 1692000, 164914003
Dutch elektrocardiogram P pulmonale
French Coeur pulmonaire à l'électrocardiogramme
Italian Onda P polmonare dell'elettrocardiogramma
Portuguese Electrocardiograma P pulmonale
Spanish P pulmonar en el electrocardiograma, P pulmonar (hallazgo), P pulmonar, signos electrocardiográficos de P pulmonar (hallazgo), signos electrocardiográficos de P pulmonar
Japanese 心電図肺性P波, シンデンズハイセイPハ
English P pulmonale by EKG (finding), p pulmonale, Right Atrial Enlargement by ECG Finding, P pulmonale by electrocardiogram (finding), P pulmonale by electrocardiogram, P pulmonale by EKG, P-pulmonale by EKG Finding, Right Atrial Enlargement, P-pulmonale by ECG Finding, RIGHT ATRIAL ABNORMALITY, P-pulmonale, P pulmonale, P pulmonale (finding), Electrocardiogram P pulmonale
Czech Elektrokardiogram P pulmonale
Hungarian Elektrokardiogram P pulmonale
German Elekrokardiogramm P pulmonale

Ontology: P mitrale (finding) (C0232310)

Definition (NCI) An electrocardiographic finding suggesting underlying hypertrophy or dilatation of the left atrium. Electrocardiographic criteria used for the diagnosis of left atrial abnormality may include a bifid p wave, a biphasic p wave and/or a p wave duration of greater than 0.12 seconds.
Definition (NCI_CDISC) An electrocardiographic finding suggesting underlying hypertrophy or dilatation of the left atrium. Electrocardiographic criteria used for the diagnosis of left atrial abnormality may include a bifid p wave, a biphasic p wave and/or a p wave duration of greater than 0.12 seconds. (NCI)
Concepts Finding (T033)
SnomedCT 142073008, 4725002, 164913009
English P mitrale (finding), Left Atrial Enlargement by ECG Finding, P mitrale by electrocardiogram, P mitrale by EKG, P mitrale by EKG (finding), P mitrale by electrocardiogram (finding), Left Atrial Enlargement, P-mitrale by ECG Finding, P-mitrale by EKG Finding, P-mitrale, LEFT ATRIAL ABNORMALITY, P mitrale
Spanish P mitral (hallazgo), P mitral, signos electrocardiográficos de P mitral (hallazgo), signos electrocardiográficos de P mitral

Ontology: P wave feature (C0429084)

Definition (NCI) An electrocardiographic finding of the current of atrial contraction when they are depolarized. The initial portion of the P wave is largely a reflection of right atrial depolarization and the terminal portion reflects depolarization of the left atrium.
Concepts Organism Attribute (T032)
SnomedCT 142070006, 33405001
LNC MTHU024602
English p wave, p waves, P Wave, P wave (observable entity), P wave, P wave feature (observable entity), P wave feature
Spanish onda P (entidad observable), onda P