Inverted P waves

Inverted P waves are upside down. This can be normal (i.e. lead aVR) or abnormal (i.e. leads II, III, aVF). If they are abnormal, the rhythm may be not originating from the SA node (e.g. atrial or junctional rhythms) or the electrodes may have been swapped around. Atrial rhythms will have a normal PR interval (i.e. 3-5 small squares) while junctional rhythms will have a short PR interval (less than 3 small squares at standard settings).

See also: P wave

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ECG Library (10)

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In the ECGquest archives, this ECG has been tagged with: - 12-Lead Inverted P waves Atrial tachycardia Dr Smith's ECG Blog CC BY-NC
Regular, steady, and fast at 170 (wide or narrow?), hypoxic, crackles in lungs, B-lines, unconscious. Repeat ECG after fluids.

This ECG is from a man in his 60s who was found unconscious and hypoxic.

This ECG shows atrial tachycardia with negative P waves in V1-V2.

12-Lead Inverted P waves Atrial tachycardia Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - 12-Lead Incorrect Machine Interpretation Inverted P waves Narrow QRS Retrograde P waves Short PR Accelerated junctional rhythm Dr Smith's ECG Blog CC BY-NC
What is going on here?? (The computer called it “STEMI” and “Intraventricular Conduction Delay”!!)
12-Lead Incorrect Machine Interpretation Inverted P waves Narrow QRS Retrograde P waves Short PR Accelerated junctional rhythm Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - 12-Lead Electrode misplacement Extreme Axis Inverted P waves Inverted T waves Normal rate Regular ECG of the Week CC-BY-NC-SA
ECG of the Week – 24th September 2018 – Interpretation

This ECG is from a male in his teens who presented with episodes of his hands turning cold and blue for several hours at a time.

12-Lead Electrode misplacement Extreme Axis Inverted P waves Inverted T waves Normal rate Regular ECG of the Week CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Incorrect Machine Interpretation Inverted P waves Lead misplacement Dr Smith's ECG Blog CC BY-NC
Chest pain and T-wave inversion in lead V2

This ECG is from a healthy young man who presented with chest pain. This was the initial ECG.

Chest pain 12-Lead Incorrect Machine Interpretation Inverted P waves Lead misplacement Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Palpitations 12-Lead Inverted P waves Narrow QRS Normal Axis Normal rate Short PR Accelerated junctional rhythm ECG of the Week CC-BY-NC-SA
ECG of the Week – 30th April 2018 – Interpretation

This ECG is from a man in his 70s who presented after an episode of palpitations at home. He had a past history of paroxysmal atrial fibrillation, CABG, diabetes and had undergone a MAZE procedure in the last 12 months.

Palpitations 12-Lead Inverted P waves Narrow QRS Normal Axis Normal rate Short PR Accelerated junctional rhythm ECG of the Week CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - 12-Lead High V1/V2 misplacement Inverted P waves RSR' Atrial Rhythms Normal ST elevation Dr Smith's ECG Blog CC BY-NC
Are these Wellens’ waves?
12-Lead High V1/V2 misplacement Inverted P waves RSR' Atrial Rhythms Normal ST elevation Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Flat T waves Inverted P waves Narrow QRS Normal Axis Regular Short PR Tachycardia Atrial tachycardia ECG of the Week CC-BY-NC-SA
ECG of the Week – 14th August 2017 – Interpretation
Chest pain 12-Lead Flat T waves Inverted P waves Narrow QRS Normal Axis Regular Short PR Tachycardia Atrial tachycardia ECG of the Week CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST depression Biphasic T waves Inferior ST elevation Inverted P waves Inverted T waves Narrow QRS Normal Axis Normal PR Normal rate Regular Acute Inferior MI ECG of the Week CC-BY-NC-SA
ECG of the Week – 10th July 2017 – Interpretation
Chest pain 12-Lead Anterior ST depression Biphasic T waves Inferior ST elevation Inverted P waves Inverted T waves Narrow QRS Normal Axis Normal PR Normal rate Regular Acute Inferior MI ECG of the Week CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - Dyspnoea Palpitations 12-Lead Inverted P waves Narrow QRS Normal Axis Regular Tachycardia SVT ECG of the Week CC-BY-NC-SA
ECG of the Week – 29th May 2017 – Interpretation
Dyspnoea Palpitations 12-Lead Inverted P waves Narrow QRS Normal Axis Regular Tachycardia SVT ECG of the Week CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - 12-Lead Inverted P waves Narrow QRS Normal Axis Regular Tachycardia Atrial tachycardia LITFL CC-BY-NC-SA
Atrial tachycardia
12-Lead Inverted P waves Narrow QRS Normal Axis Regular Tachycardia Atrial tachycardia LITFL CC-BY-NC-SA
This is a library of 2394 free, open access, re-usable ECGs from across the web.

Where did they come from?

These ECGs were collected from Free Open Access Medical Education (#FOAMed) blogs, with the permission of their authors. You can find out more about each ECG's source by clicking on it.

Why are they here?

This is an experiment in digital curation. The idea is to collect resources to increase awareness and accessibility. Over time, more ECGs in the collection will be tagged to make it easier to find them and reused in new interactive quizzes.

How can I use these ECGs?

You can use these ECGs for your own learning, teaching or research - as long as you abide by the terms of each ECG's copyright licence as stipulated by the original author.