What does a missing P wave indicate?

Absence of P Waves A lack of visible P waves preceding QRS complexes suggests a lack of sinus beats; this may occur with sinus dysfunction or in the presence of fibrillation or flutter waves. The P wave may also be hidden within the QRS complex.

What are the P wave and QRS complex related to?

The P wave in an ECG complex indicates atrial depolarization. The QRS is responsible for ventricular depolarization and the T wave is ventricular repolarization. If a P wave is absent there is a lack of atrial depolarization. This is also known as atrial standstill.

What does the P wave indicate?

The P wave represents the electrical depolarization of the atria. In a healthy person, this originates at the sinoatrial node (SA node) and disperses into both left and right atria.

What does tall P waves mean?

The presence of tall, peaked P waves in lead II is a sign of right atrial enlargement, usually due to pulmonary hypertension (e.g. cor pulmonale from chronic respiratory disease).

What causes delay between P wave and QRS complex?

Second-degree AV nodal block – the conduction velocity is slowed to the point where some impulses from the atria cannot pass through the AV node. This results in P waves that are not followed by QRS complexes. There are two subtypes of second-degree AV blocks: Mobitz Type I and Mobitz Type II.

What heart rhythm has no P waves?

Accelerated junctional rhythm (nodal tachycardia) is a regular narrow-complex tachycardia in which no P wave can be seen preceding the QRS complex. The tachycardia typically develops gradually (warm up), slowly increasing up to a heart rate of 110 to 150 beats per minute.

What causes abnormal P waves?

An abnormal P wave may indicate atrial enlargement. Atrial depolarization follows the discharge of the sinus node. Normally depolarization occurs first in the right atrium and then in the left atrium. Atrial enlargement is best observed in the P waves of leads II and V1.

What does a wide QRS indicate?

A “wide QRS complex” refers to a QRS complex duration ≥120 ms. Widening of the QRS complex is related to slower spread of ventricular depolarization, either due to disease of the His-Purkinje network and/or reliance on slower, muscle-to-muscle spread of depolarization.

How do you treat a wide QRS complex?

Treatment / Management

1. SVT will typically be managed with adenosine, Afib with WPWS will be treated with amiodarone, and Afib with aberrancy with either diltiazem or a beta-blocker.
2. Typically, amiodarone will be the first-line drug of choice for all ventricular arrhythmias (VT, polymorphic VT, Vfib, etc.)

Why are there no P waves before QRS complexes?

A lack of visible P waves preceding QRS complexes suggests a lack of sinus beats; this may occur with sinus dysfunction or in the presence of fibrillation or flutter waves. The P wave may also be hidden within the QRS complex.

When do inverted P waves appear in an EKG?

Inverted (negative) or absent P waves are seen before each QRS complex OR P wave can be hidden in the QRS complex OR P wave may follow the QRS complex PR interval of <0.12 seconds (remember normal is 0.12-0.2) QRS complex within normal measurements

Why are there no P waves in my Heart?

Absence of P Waves. A lack of visible P waves preceding QRS complexes suggests a lack of sinus beats; this may occur with sinus dysfunction or in the presence of fibrillation or flutter waves. The P wave may also be hidden within the QRS complex. Atria. Ventricles.

What causes the shape of a QRS complex?

• Shape of an abnormal QRS complex varies from almost normal to wide and bizarre and/or slurred and notched. • Tall QRS complexes are usually caused by hypertrophy of one or both ventricles, or by an abnormal pacemaker or aberrantly conducted beat. • Low voltage or abnormally small QRS complexes may