P Wave Morphology: Difference between revisions

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===Left atrial enlargement===
;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.
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===Right atrial enlargement===
;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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===Biatrial enlargement===
;Biatrial enlargement
:Biphasic p wave in V1 of more than 0.04 sec duration. The positive initial part is > 1.5mm and the negative terminal part > 1mm
In biatrial enlargement is the ECG whos signs of both left and right atrial enlargement. In V1 the p wave has large peaks first in positive and later in negative direction.


==Referenties==
==Referenties==

Revision as of 23:11, 17 June 2007

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

The p wave morphology can reveal right or left atrial stretch.

The P-wave morphology is best determined in leads II and V1 during sinus rhythm.

The normal P wave

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:[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 bifasic in V1
  • The p wave duration is usually 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 Atrial infarction or pericarditis.

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


Referenties

  1. Spodick DH, Raju P, Bishop RL, and Rifkin RD. Operational definition of normal sinus heart rate. Am J Cardiol. 1992 May 1;69(14):1245-6. DOI:10.1016/0002-9149(92)90947-w | PubMed ID:1575201 | HubMed [Spodick]

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