Hidden P waves

P waves can be hidden if they occur during the T wave. This can occur when the rate is fast (e.g. Sinus Tachycardia) or with conduction blocks. Lewis leads can help to uncover the P waves.

See also: P wave

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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: - Fatigue Hypotension Weakness Regular Tachycardia Hidden P waves Narrow QRS Sinus tachycardia 12-Lead Serial 12-lead Dr Smith's ECG Blog CC BY-NC
Atrial fibrillation with RVR: use POCUS to assess volume; then sinus vs. SVT: use of Lewis leads. Repeat after IVF