P Wave Morphology: Difference between revisions

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The ''p wave morphology'' can reveal right or left atrial stretch.
|previouspage=Heart axis
 
|previousname=Step 4:Heart axis
The P-wave morphology is best determined in leads II and V1 during sinus rhythm.
|nextpage=QRS morphology
|nextname=Step 6: QRS morphology
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{{authors|
|mainauthor= [[user:Drj|J.S.S.G. de Jong, MD]], A. Bouhiouf, Msc
|supervisor=
|coauthor=
|moderator= [[user:Drj|J.S.S.G. de Jong, MD]]
|editor=
}}
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==The Normal P wave==
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The '''P wave morphology''' can reveal right or left atrial hypertrophy or atrial arrhythmias and is best determined in leads II and V1 during sinus rhythm.


===The normal P wave===
'''Characteristics of a normal p wave:'''<cite>Spodick</cite>
[[Image:normalSR.jpg|thumb|Normal sinus rhythm with a positive p wave in leads I, II en AVF and a biphasic p wave in V1.]]
Characteristics of a normal p wave:<cite>Spodick</cite>
*The maximal height of the P wave is 2.5 mm in leads II and / or III
*The maximal height of the P wave is 2.5 mm in leads II and / or III
*The p wave is positive in II and AVF, and bifasic in V1
*The p wave is positive in II and AVF, and biphasic in V1
*The p wave duration is usually shorter than 0.12 seconds
*The p wave duration is shorter than 0.12 seconds
 
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Elevation or depression of the PTa segment (the part between the p wave and the beginning of the QRS complex) can result from [[Ischemia#Atrial infarction|Atrial infarction]] or [[Miscelaneous#Pericarditis|pericarditis]].
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{| class="wikitable"
If the p-wave is enlarged, the atria are enlarged.
|-
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| |[[Image:Normaal ecg.jpg|thumb|center|300px|An example of normal sinus rhythm.]]
| |[[Image:Nsr.jpg|300px|thumb|center}Another example of normal sinus rhythm.]]
|}
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==The Abnormal P wave==


===Left atrial enlargement===
Elevation or depression of the [[PTa segment]] (the part between the p wave and the beginning of the QRS complex) can result from [[Ischemia#Atrial infarction|atrial infarction]] or [[Clinical Disorders#Pericarditis|pericarditis]].
Criteria for left atrial voor left atrial enlargement:
P wave with a broad (>0,04 sec or 1 small square) and deeply negative (>1 mm) terminal part in V1, and / or >0,12 sec in laeds I and / or II
[[Image:left_atrial_enlargement.jpg|thumb| Left atrial enlargement]]
[[Image:LAE_2.png|thumb| Left atrial enlargement with ECG.]]
[[Image:ECG_LAtrD_v1.jpg|thumb| Left atrial enlargement as seen in lead V1.]]
'''Left atrial enlargement''' is often seen in mitral valve insufficiency.  
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===Rechterariumbelasting===
If the p-wave is enlarged, the [[Chamber_Hypertrophy_and_Enlargment#Left_atrial_enlargement|atria are enlarged]].
Criteria voor RA-hypertrofie/-overbelasting:
P >2,5 mm in II en/of III en/of aVF, en/of P >1,5 mm in V1(eerste positieve deel--> vector is anterior georienteerd)).
[[Image:right_atrial_enlargement.jpg|thumb| Rechter atrium dilatatie]]
[[Image:Rae.png|thumb| Rechter atrium dilatatie]]
'''Rechteratriumbelasting''' kan een aanwijzing zijn voor een hoge druk in de ateria pulmonalis, bijvoorbeeld bij een longembolie. Op het ECG (V1) is een groot eerste deel van de bifasiche P-top een teken voor rechter-boezemhypertrofie. De breedte van de P-top blijft normaal. De toename in de activatieduur van de rechteratria valt samen met die van de linkeratria en zal dus niet detecteerbaar zijn.
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===Biatriale belasting===
If the P wave is inverted, it is most likely an [[ectopic atrial rhythm]] not originating from the sinus node.
Bifasische P in V1 > 0.04 sec, positief initieël deel >1.5mm en een negatief terminaal deel > 1mm
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'''Biatriale belasting''' vertoont op het ECG tekenen van zowel rechter- als linkeratriumhypertrofie. V1 laat een groot eerste deel van de bifasische P-top en een diep breed tweede deel van de bifaische P-top zien.
{| class="wikitable"
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{|
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| | [[Image:p_wave_morphology.png|center|thumb|300px|Altered P wave morphology is seen in left or right atrial enlargement.]]
| | [[Image:pta_changes.svg|thumb|center|300px|The PTa segment can be used to diagnose pericarditis or atrial infarction.]]
|}
|}
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==Referenties==
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==References==
<biblio>
<biblio>
#Spodick pmid=1575201
#Spodick pmid=1575201
</biblio>
</biblio>
<analytics uacct="UA-807577-6"></analytics>
}}
 
[[Category:ECG Course]]

Latest revision as of 08:39, 12 January 2011

«Step 4:Heart axis Step 6: QRS morphology»


Author(s) J.S.S.G. de Jong, MD, A. Bouhiouf, Msc
Moderator J.S.S.G. de Jong, MD
Supervisor
some notes about authorship


The Normal P wave

The P wave morphology can reveal right or left atrial hypertrophy or atrial arrhythmias and is best determined in leads II and V1 during sinus rhythm.

Characteristics of a normal p wave:[1]

  • The maximal height of the P wave is 2.5 mm in leads II and / or III
  • The p wave is positive in II and AVF, and biphasic in V1
  • The p wave duration is shorter than 0.12 seconds
An example of normal sinus rhythm.
center}Another example of normal sinus rhythm.

The Abnormal P wave

Elevation or depression of the PTa segment (the part between the p wave and the beginning of the QRS complex) can result from atrial infarction or pericarditis.

If the p-wave is enlarged, the atria are enlarged.

If the P wave is inverted, it is most likely an ectopic atrial rhythm not originating from the sinus node.

Altered P wave morphology is seen in left or right atrial enlargement.
The PTa segment can be used to diagnose pericarditis or atrial infarction.


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