P Wave Morphology: Difference between revisions

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|previouspage=Heart axis
|previousname=Step 4:Heart axis
|nextpage=QRS morphology
|nextname=Step 6: QRS morphology
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{{authors|
|mainauthor= [[user:Drj|J.S.S.G. de Jong, MD]]
|mainauthor= [[user:Drj|J.S.S.G. de Jong, MD]], A. Bouhiouf, Msc
|advisor=
|supervisor=
|coauthor=
|coauthor=
|moderator= [[user:Drj|J.S.S.G. de Jong, MD]]
|moderator= [[user:Drj|J.S.S.G. de Jong, MD]]
|editor= A. Bouhiouf, Msc
|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 ''p wave morphology'' can reveal right or left atrial stretch.
'''Characteristics of a normal p wave:'''<cite>Spodick</cite>
 
The P-wave morphology is best determined in leads II and V1 during sinus rhythm.
 
===The normal P wave===
[[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
 
}}
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. Either
:P wave with a broad (>0,04 sec or 1 small square) and deeply negative (>1 mm) terminal part in V1
:P wave duration >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, resulting in backflow of blood from the left ventricle to the left atrium and subsequent incresed local pressure.  
{{clr}}


===Right atrial enlargement===
If the p-wave is enlarged, the [[Chamber_Hypertrophy_and_Enlargment#Left_atrial_enlargement|atria are enlarged]].
;Right atrial enlargement is defined as either:
:P >2,5 mm in II / III and / or aVF
:P >1,5 mm in V1.
[[Image:right_atrial_enlargement.jpg|thumb|  Right atrial enlargement]]
[[Image:Rae.png|thumb| Right atrial enlargement]]
Right atrial enlargement can result from increased pressure in the pulmonary artery, e.g. after pulmonary embolisation. A positive part of the biphasic p-wave in lead V1 larger than the negative part indicates right atrial enlargement. The width of the p wave does not change.  
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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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