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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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.