Absent P waves

An absent P wave suggests that the rhythm is not a sinus rhythm. This can be difficult to detect as P waves can sometimes be hidden in the waves before or after them, and sometimes they are very small and hard to see – especially if there is baseline artefact.

See also: P wave

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References

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In the ECGquest archives, this ECG has been tagged with: - Absent P waves Peaked T waves Accelerated idioventricular rhythm Hyperkalemia 12-Lead EMergucate CC-BY-NC-SA
ECG of the Week Interpretation – March 20th 2019

This ECG is from a man in his 60s who presented with fever and delirium. He has a history of renal failure, T2DM and cognitive impairment.

This ECG shows accelerated idioventricular rhythm with peaked T waves due to hyperkalemia.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea Bradycardia Irregular Normal Axis Absent P waves Hidden P waves Narrow QRS Short PR Change in rhythm Junctional escape Multiple rhythms Sinus arrhythmia Sinus bradycardia 12-Lead Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
What is the Rhythm?

This ECG is from a young man who presented shortly after a 45 min episode of palpitations, shortness of breath, chest pressure and presyncope. He was an athlete.

This ECG shows marked sinus bradycardia with AV dissociation by default (not AV block) with junctional escape beats.

In the ECGquest archives, this ECG has been tagged with: - Palpitations Extreme tachycardia Normal Axis Regular Tachycardia Absent P waves Narrow QRS ST elevation in aVR Widespread ST depression SVT 12-Lead ECG of the Week CC-BY-NC-SA
ECG of the Week – 7th January 2019 – Interpretation

This ECG is from a woman in her 20s who presented with palpitations for an hour.

This ECG shows a regular narrow complex tachycardia (SVT) with secondary ST segment changes due to the extreme rate (205 bpm).

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea Extreme tachycardia Normal Axis Regular Tachycardia Absent P waves Anterior ST depression Inferior ST elevation Narrow QRS Reciprocal ST depression Atrial flutter Multi-vessel disease 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

This ECG is from a man in his 60s who presented with intermittent shortness of breath and chest pressure over the past few days. This was his initial ECG.

This ECG shows a regular narrow complex tachycardia around 200 bpm, without P waves, with marked ST elevation in inferior leads and ST depression in anterior leads and aVL. The cause was thought to be atrial flutter from newly started flecainide. He also underwent angiography and had stents inserted to the left circumflex and right coronary arteries.

In the ECGquest archives, this ECG has been tagged with: - Bradycardia Irregular Normal Axis Absent P waves RSR' Wide QRS Atrial fibrillation 12-Lead ECG of the Week CC-BY-NC-SA
ECG of the Week – 1st October 2018 – Interpretation

This ECG is from a man in his 80s who presented feeling generally unwell and nauseous, on a background of chronic atrial fibrillation, diabetes and hypertension.

In the ECGquest archives, this ECG has been tagged with: - Dizziness Bradycardia Normal Axis Regular Absent P waves Atrial fibrillation Junctional escape Third degree AV block 12-Lead ECG of the Week CC-BY-NC-SA
ECG of the Week – 17th September 2018 – Interpretation

This ECG is from a woman in her 70s who complained of dizziness on a background of ischaemic heart disease, atrial fibrillation and diabetes.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Hypotension Tachycardia Absent P waves Short QRS Pericardial effusion 12-Lead Dr Smith's ECG Blog CC BY-NC
A Middle-Aged Man with Chest pain, Hypotension and Tachycardia

This ECG is from a middle-aged man who presented with chest pain, tachycardia 130 bpm and BP 50/30. He was alert but cool and clammy. His background was unclear, but he mentioned chronic dyspnoea, 'cancer' and 'chest'. Fluids were started. This was his initial ECG.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Hypotension Regular Tachycardia Absent P waves Short QRS Atrial flutter Pericardial effusion 12-Lead Dr Smith's ECG Blog CC BY-NC
A Middle-Aged Man with Chest pain, Hypotension and Tachycardia: ED ECG 1

This ECG is from a middle-aged man who presented with chest pain, tachycardia 130 bpm and BP 50/30. He was alert but cool and clammy. His background was unclear, but he mentioned chronic dyspnoea, 'cancer' and 'chest'. Fluids were started. This was his second ECG, on arrival at hospital.

In the ECGquest archives, this ECG has been tagged with: - Chronic kidney disease Weakness Bradycardia Absent P waves Peaked T waves Wide QRS Hyperkalemia 12-Lead Dr Smith's ECG Blog CC BY-NC
Potato Poisoning (Not due to Solanine in greens!). With Positive Modified Sgarbossa Criteria.

This ECG is from a male of unknown age who presented with progressive weakness over 3 days, on a background of haemodialysis, cardiomyopathy, diabetes and hypertension.

This ECG shows wide QRS complexes with peaked T waves caused by hyperkalemia.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dizziness Left Axis Deviation Absent P waves Discordant ST changes Pacemaker spikes Wide QRS 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
ECG of the Week – 2nd April 2018 – Interpretation

This ECG is from a man in his 70s who presented following several episodes of chest pain and dizziness.

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