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With either of these rhythms, if the ventricular rate is fast, the fibrillatory or flutter waves can easily be misinterpreted as P waves. Absence of the P wave with a flat baseline may indicate: Fine atrial fibrillation [1] Sinoatrial arrest (with a secondary escape rhythm) If P waves are not clearly delineated in the surface ECG, a Lewis lead ...
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.
Electrocardiography may show P mitrale, that is, broad, notched P waves in several or many leads with a prominent late negative component to the P wave in lead V 1, and may also be seen in mitral regurgitation, and, potentially, any cause of overload of the left atrium. [14] Thus, P-sinistrocardiale may be a more appropriate term. [14]
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.
P mitrale is a broad, bifid notched P wave in several or many leads with a prominent late negative component to the P wave in lead V 1, and may be seen in MR, but also in mitral stenosis, and, potentially, any cause of overload of the left atrium. [18]
By convention, the term "normal sinus rhythm" is taken to imply that not only are the P waves (reflecting activity of the sinus node itself) normal in morphology but that all other ECG measurements are also normal. [3] [5] Criteria therefore include: Normal heart rate (classically 60 to 100 beats per minute for an adult).
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.