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P-wave changes in left and right atrial hypertrophy. Bifid P waves (known as P mitrale) indicate left-atrial abnormality - e.g. dilatation [6] or hypertrophy. [1] If at least three different shaped P waves can be seen in a given ECG lead tracing, this implies that even if one of them arises from the SA node, at least two others are arising ...
Right Atrial Enlargement (RAE) increases the p wave, representing atrial depolarization, on an ECG to an amplitude > 2.5mm in lead II, an abnormality referred to as p-pulmonale, likely due to weakened right atrial myocardium close to the Sinoatrial (SA) node.
The P wave is typically upright in most leads except for aVR; an unusual P wave axis (inverted in other leads) can indicate an ectopic atrial pacemaker. If the P wave is of unusually long duration, it may represent atrial enlargement. Typically a large right atrium gives a tall, peaked P wave while a large left atrium gives a two-humped bifid P ...
A wandering atrial pacemaker can be either normal or irregular in rate, much like a sinus arrhythmia the rate is normally between 60 - 100 bpm when it is normal and less than 60 when it is slow, the distinguishing feature of this rhythm is a p wave that varies in size, shape, and direction, the PR interval can either be normal or irregular ...
ECG of V1 showing the large negative of the P wave indicating left atrial enlargement [6] LAE is suggested by an electrocardiogram (ECG) that has a pronounced notch in the P wave. [7] However, if atrial fibrillation is present, a P wave would not be present. [8]
On an ECG, the QRS complex will be abnormally shaped when looking at ventricular ectopic activity, often it occurs earlier with an absent P wave. It can be perceived as a skipped beat on both the ECG and through normal pulse-taking. [12] During atrial ectopic activity where the P wave is normally rounded can be inverted or peaked.
The most obvious abnormal finding will be abnormal P waves. One of three options can occur: [12] 1. There are no P waves. This is because of either failure of retrograde flow to the atria or the P wave is hidden in the QRS. If the P wave is hidden that implies the atria depolarize at the same time as the ventricles. 2.
Other common changes that are seen on ECG with wandering atrial pacemaker include differing PR intervals and PP intervals. Another heart rhythm similar to wandering atrial pacemaker is multifocal atrial tachycardia. Both arrhythmias have at least 3 different P-wave morphologies in a single ECG lead, but the heart rate is different.