ECG Quest > Shapes > P wave > Inverted P waves

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). 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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References

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In the ECGquest archives, this ECG has been tagged with: - Inverted P waves Atrial tachycardia 12-Lead 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.

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

Electrode misplacement Extreme Axis Normal rate Regular Inverted P waves Inverted T waves 12-Lead ECG of the Week CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - Chest pain Incorrect Machine Interpretation Inverted P waves Lead misplacement 12-Lead 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 Incorrect Machine Interpretation Inverted P waves Lead misplacement 12-Lead Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Palpitations Normal Axis Normal rate Inverted P waves Narrow QRS Short PR Accelerated junctional rhythm 12-Lead ECG of the Week Dr John Larkin 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 Normal Axis Normal rate Inverted P waves Narrow QRS Short PR Accelerated junctional rhythm 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - High V1/V2 misplacement Inverted P waves RSR' Atrial Rhythms Normal ST elevation 12-Lead Dr Smith's ECG Blog CC BY-NC
Are these Wellens’ waves?
High V1/V2 misplacement Inverted P waves RSR' Atrial Rhythms Normal ST elevation 12-Lead Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain Normal Axis Regular Tachycardia Flat T waves Inverted P waves Narrow QRS Short PR Atrial tachycardia 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
ECG of the Week – 14th August 2017 – Interpretation
Chest pain Normal Axis Regular Tachycardia Flat T waves Inverted P waves Narrow QRS Short PR Atrial tachycardia 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - Chest pain Normal Axis Normal rate Regular Anterior ST depression Biphasic T waves Inferior ST elevation Inverted P waves Inverted T waves Narrow QRS Normal PR Acute Inferior MI 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
ECG of the Week – 10th July 2017 – Interpretation
Chest pain Normal Axis Normal rate Regular Anterior ST depression Biphasic T waves Inferior ST elevation Inverted P waves Inverted T waves Narrow QRS Normal PR Acute Inferior MI 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - Dyspnoea Palpitations Normal Axis Regular Tachycardia Inverted P waves Narrow QRS SVT 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
ECG of the Week – 29th May 2017 – Interpretation
Dyspnoea Palpitations Normal Axis Regular Tachycardia Inverted P waves Narrow QRS SVT 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - Normal Axis Regular Tachycardia Inverted P waves Narrow QRS Atrial tachycardia 12-Lead LITFL Dr Edward Burns CC-BY-NC-SA
Atrial tachycardia
Normal Axis Regular Tachycardia Inverted P waves Narrow QRS Atrial tachycardia 12-Lead LITFL Dr Edward Burns CC-BY-NC-SA
This is a library of 2358 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.