ECG Quest > Shapes > P wave > Normal P waves

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.

See also: P wave

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In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea Normal Axis Regular Tachycardia Anterior ST depression Inferior ST elevation Narrow QRS Normal P waves Reciprocal ST depression Sinus tachycardia Multi-vessel disease 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer 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 Normal Axis Regular Tachycardia Anterior ST depression Inferior ST elevation Narrow QRS Normal P waves Reciprocal ST depression Sinus tachycardia Multi-vessel disease 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Normal Axis Regular Narrow QRS Normal P waves Normal 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer 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.

Normal Axis Regular Narrow QRS Normal P waves Normal 12-Lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea Normal P waves Takotsubo cardiomyopathy 12-Lead Dr Smith's ECG Blog Dr Ken Grauer 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 Normal P waves Takotsubo cardiomyopathy 12-Lead Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea Deeply inverted T waves Normal P waves Takotsubo cardiomyopathy 12-Lead Dr Smith's ECG Blog Dr Ken Grauer 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 Deeply inverted T waves Normal P waves Takotsubo cardiomyopathy 12-Lead Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain Chronic kidney disease Normal Axis Normal P waves 12-Lead Serial 12-lead Dr Pendell Meyers 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 Normal Axis Normal P waves 12-Lead Serial 12-lead Dr Pendell Meyers Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chronic kidney disease Normal Axis Normal P waves 12-Lead Serial 12-lead Dr Pendell Meyers 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 Normal Axis Normal P waves 12-Lead Serial 12-lead Dr Pendell Meyers Dr Smith's ECG Blog CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea Tachycardia Fragmented QRS Normal P waves Wide QRS Sinus tachycardia Wide complex tachycardia LBBB 12-Lead Serial 12-lead Dr Smith's ECG Blog Dr Ken Grauer 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 Tachycardia Fragmented QRS Normal P waves Wide QRS Sinus tachycardia Wide complex tachycardia LBBB 12-Lead Serial 12-lead Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - High V1/V2 misplacement Normal Axis Normal P waves Normal T waves Normal Sinus Rhythm Normal 12-Lead Serial 12-lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer 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.

High V1/V2 misplacement Normal Axis Normal P waves Normal T waves Normal Sinus Rhythm Normal 12-Lead Serial 12-lead Dr Pendell Meyers Dr Smith's ECG Blog Dr Ken Grauer CC BY-NC
In the ECGquest archives, this ECG has been tagged with: - Bradycardia Normal Axis Early R wave transition Narrow QRS Normal P waves Normal PR Tall QRS Sinus arrhythmia Sinus bradycardia 12-Lead ECG of the Week Dr John Larkin 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.

Bradycardia Normal Axis Early R wave transition Narrow QRS Normal P waves Normal PR Tall QRS Sinus arrhythmia Sinus bradycardia 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
In the ECGquest archives, this ECG has been tagged with: - Dizziness Palpitations Normal Axis Standard Calibration Delta wave Normal P waves Short PR Wide QRS Wolff Parkinson White syndrome 12-Lead ECG of the Week Dr John Larkin 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 Normal Axis Standard Calibration Delta wave Normal P waves Short PR Wide QRS Wolff Parkinson White syndrome 12-Lead ECG of the Week Dr John Larkin CC-BY-NC-SA
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This is a library of 2321 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.