Normal findings
1. Upright: I, II, avF, V4, V5, V6
2. Inverted: aVR
3. Variable: III, avL, V1, V2, V3
P Wave Inversion (other than aVR)
1. Ectopic atrial focus
2. AV nodal rhythm
High Amplitude: Atrial hypertrophy or atrial dilatation
1. Mitral valve or tricuspid valve disease
2. Hypertension
3. Cor Pulmonale
4. Congenital Heart Disease
Wide P Wave (over .11 sec)
1. Left atrial enlargement
Biphasic P Wave (second half negative in III or V1)
1. Left Atrial Enlargement
M shaped or notched P Wave
1. M-Mitral: Left atrial enlargement
2. Findings
  1. Over 0.04 seconds between peaks
  2. Taller in I than in III
Peaked P Wave
1. P-Pulmonale: Right atrial enlargement
2. Findings
  1. Tall and pointed
  2. Taller in Lead III than in I
P Waves absent
1. Sinoatrial node block
2. AV Nodal rhythm

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This page was written by Scott Moses, MD. This page was last revised on 4/26/2008 9:07:45 PM. This page was last published on 4/29/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.