Normal P waves

A normal P wave is positive (upright) in leads I and II, but negative (inverted) in aVR. It should be less than 3 small squares wide (120 ms), and less than 2.5 mm tall (or <1.5 mm in the chest leads V1-V6) at standard settings.

Featured Example

ECG of the Week

References

Related

  • See also: P wave
  • Irregularly irregular rhythms:

ECG Library (85)

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In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Bradycardia Changing PR interval Narrow QRS Normal P waves Short PR Junctional escape Sinus arrhythmia Sinus bradycardia ECG Interpretation CC-BY-NC-SA
ECG Blog #159 (Bradycardia – AV Block – AV Dissociation – Junctional)
Chest pain 12-Lead Bradycardia Changing PR interval Narrow QRS Normal P waves Short PR Junctional escape Sinus arrhythmia Sinus bradycardia ECG Interpretation CC-BY-NC-SA
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In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Anterior ST depression Inferior ST elevation Narrow QRS Normal Axis Normal P waves Reciprocal ST depression Regular Tachycardia Sinus tachycardia Multi-vessel disease Dr Smith's ECG Blog CC BY-NC
Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide. Repeat 1 min later.

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 repeat ECG after the rhythm changed.

This ECG shows a sinus tachycardia with ST elevation in inferior leads and ST depression in anterior leads and aVL. He underwent angiography and had stents inserted to the left circumflex and right coronary arteries.

Chest pain Dyspnoea 12-Lead Anterior ST depression Inferior ST elevation Narrow QRS Normal Axis Normal P waves Reciprocal ST depression Regular Tachycardia Sinus tachycardia Multi-vessel disease Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - 12-Lead Narrow QRS Normal Axis Normal P waves Normal R wave transition Regular Normal Dr Smith's ECG Blog CC BY-NC
Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide. Baseline ECG.

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 baseline ECG for comparison.

This ECG shows a normal ECG.

12-Lead Narrow QRS Normal Axis Normal P waves Normal R wave transition Regular Normal Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Deeply inverted T waves Normal P waves Takotsubo cardiomyopathy Dr Smith's ECG Blog CC BY-NC
A 60 year old patient with large T-wave inversions

This ECG is from a woman in her 60s who presented with intermittent chest pain and dyspnoea for the past day, on a background of stage IV lung cancer. This was her repeat ECG the next day.

Chest pain Dyspnoea 12-Lead Deeply inverted T waves Normal P waves Takotsubo cardiomyopathy Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Normal P waves Takotsubo cardiomyopathy Dr Smith's ECG Blog CC BY-NC
A 60 year old patient with large T-wave inversions

This ECG is from a woman in her 60s who presented with intermittent chest pain and dyspnoea for the past day, on a background of stage IV lung cancer. This was her baseline ECG.

Chest pain Dyspnoea 12-Lead Normal P waves Takotsubo cardiomyopathy Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain Chronic kidney disease 12-Lead Serial 12-lead Normal Axis Normal P waves Dr Smith's ECG Blog CC BY-NC
“Are these hyperacute T-waves?” – what is your recommendation for the team in these two cases? Case 2

This ECG is from a man in his 40s who presented with crushing chest pain described as 'like my other heart attacks'. He had also missed dialysis.

Chest pain Chronic kidney disease 12-Lead Serial 12-lead Normal Axis Normal P waves Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chronic kidney disease 12-Lead Serial 12-lead Normal Axis Normal P waves Dr Smith's ECG Blog CC BY-NC
“Are these hyperacute T-waves?” – what is your recommendation for the team in these two cases? Case 2 Baseline

This ECG is from a man in his 40s who presented with crushing chest pain described as 'like my other heart attacks'. He had also missed dialysis. This was his baseline ECG.

Chronic kidney disease 12-Lead Serial 12-lead Normal Axis Normal P waves Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Serial 12-lead Fragmented QRS Normal P waves Tachycardia Wide QRS Sinus tachycardia Wide complex tachycardia LBBB Dr Smith's ECG Blog CC BY-NC
Sudden Chest pain and SOB with a Wide Complex Tachycardia: Repeat after unsynchronised cardioversion

This ECG is from a man in his 60s who presented with sudden onset severe chest pain and dyspnoea. He had no medical history or medications. On arrival he was in extremis with altered mentation, cyanosis and diaphoresis . There was no palpable radial pulse. Pulse oximetry read HR 170 and saturation 53%. This was the repeat ECG after unsynchronised cardioversion.

Chest pain Dyspnoea 12-Lead Serial 12-lead Fragmented QRS Normal P waves Tachycardia Wide QRS Sinus tachycardia Wide complex tachycardia LBBB Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - 12-Lead High V1/V2 misplacement Serial 12-lead Normal Axis Normal P waves Normal T waves Normal Sinus Rhythm Normal Dr Smith's ECG Blog CC BY-NC
A pathognomonic ECG you should recognize instantly. Baseline ECG

This ECG is from a patient of unknown age who presented with generalised weakness and malaise. This was the baseline ECG from a previous presentation.

12-Lead High V1/V2 misplacement Serial 12-lead Normal Axis Normal P waves Normal T waves Normal Sinus Rhythm Normal Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - 12-Lead Bradycardia Early R wave transition Narrow QRS Normal Axis Normal P waves Normal PR Tall QRS Sinus arrhythmia Sinus bradycardia ECG of the Week CC-BY-NC-SA
ECG of the Week – 23rd April 2018 – Interpretation

This ECG is from a man in his 40s. His history is not known.

12-Lead Bradycardia Early R wave transition Narrow QRS Normal Axis Normal P waves Normal PR Tall QRS Sinus arrhythmia Sinus bradycardia ECG of the Week CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - Dizziness Palpitations 12-Lead Standard Calibration Delta wave Normal Axis Normal P waves Short PR Wide QRS Wolff Parkinson White syndrome ECG of the Week CC-BY-NC-SA
ECG of the Week – 12th February 2018 – Interpretation

This ECG is from a 12 yr old male who presented to the Emergency Department following an episode of palpitations and near-syncope. He had no known past medical history.

Dizziness Palpitations 12-Lead Standard Calibration Delta wave Normal Axis Normal P waves Short PR Wide QRS Wolff Parkinson White syndrome ECG of the Week CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Nonspecific baseline artefact Standard Calibration Narrow QRS Normal Axis Normal P waves Normal PR Sinus tachycardia Pericarditis ECG of the Week CC-BY-NC-SA
ECG of the Week – 5th February 2018 – Interpretation
Chest pain 12-Lead Nonspecific baseline artefact Standard Calibration Narrow QRS Normal Axis Normal P waves Normal PR Sinus tachycardia Pericarditis ECG of the Week CC-BY-NC-SA
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This is a library of 2407 free, open access, re-usable ECGs from across the web.

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