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.

Featured Example

References

Related

  • See also: P wave
  • Irregular baselines:
  • Irregularly irregular rhythms:

ECG Library (68)

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In the ECGquest archives, this ECG has been tagged with: - 12-Lead Absent P waves Peaked T waves Accelerated idioventricular rhythm Hyperkalemia 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 12-Lead Absent P waves Bradycardia Hidden P waves Irregular Narrow QRS Normal Axis Short PR Change in rhythm Junctional escape Multiple rhythms Sinus arrhythmia Sinus bradycardia Dr Smith's ECG Blog 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 12-Lead Absent P waves Extreme tachycardia Narrow QRS Normal Axis Regular ST elevation in aVR Tachycardia Widespread ST depression SVT 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 12-Lead Absent P waves Anterior ST depression Extreme tachycardia Inferior ST elevation Narrow QRS Normal Axis Reciprocal ST depression Regular Tachycardia Atrial flutter Multi-vessel disease Dr Smith's ECG Blog 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: - 12-Lead Absent P waves Bradycardia Irregular Normal Axis RSR' Wide QRS Atrial fibrillation 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 12-Lead Absent P waves Bradycardia Normal Axis Regular Atrial fibrillation Junctional escape Third degree AV block 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 12-Lead Absent P waves Short QRS Tachycardia Pericardial effusion 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 12-Lead Absent P waves Regular Short QRS Tachycardia Atrial flutter Pericardial effusion 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 12-Lead Absent P waves Bradycardia Peaked T waves Wide QRS Hyperkalemia 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 12-Lead Absent P waves Discordant ST changes Left Axis Deviation Pacemaker spikes Wide QRS ECG of the Week 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.

In the ECGquest archives, this ECG has been tagged with: - Cardiac arrest 12-Lead Absent P waves Anterior ST depression Inferior ST depression Irregular Late R wave transition Lateral ST elevation Left Axis Deviation Acute Lateral MI ECG of the Week CC-BY-NC-SA
ECG of the Week – 26th March 2018 – Interpretation

This ECG is from a man in his 40s who had a cardiac arrest out of hospital. He regained cardiac output on the way to the Emergency Department.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Absent P waves Anterior ST depression Inferior ST elevation Inverted T waves Irregular Narrow QRS Normal Axis Normal rate Reciprocal ST depression Tall QRS Atrial fibrillation Acute Inferior MI Acute Posterior MI ECG of the Week CC-BY-NC-SA
ECG of the Week – 19th February 2018 – Interpretation

This ECG is from a man in his 50s who presented to the Emergency Department complaining of chest pain for 1 hour. He was an ex-smoker and had a history of hypertension and hypercholesterolaemia.

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