Inverted P Wave: Causes & Reasons

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Possible Causes for Inverted P Wave

Atrial Bigeminy

P wave with a PRI >120ms. [app.figure1.com]

[…] producing an inverted P wave with a relatively short PR interval ≥ 120 ms (PR interval < 120 ms is classified as a PJC) The abnormal P wave may be hidden in the preceding [litfl.com]

Wave: Premature and abnormal or hidden PR Interval: Less then 200ms QRS Interval: Abnormal Junctional Rhythm Heart Rate: 40 to 60 beats per minute (BPM) P Wave: Inverted, [heartrhythmguide.com]

Premature Atrial Contractions

wave is abnormal Premature (earlier than expected) Morphology different than normal P wave Inverted P wave suggests atrial source near AV junction Nearly normal P waves suggest [fprmed.com]

PACS arising close to the AV node (“low atrial” ectopics) activate the atria retrogradely, producing an inverted P wave with a relatively short PR interval ≥ 120 ms (PR interval [litfl.com]

Neurological (SAH) Drug causes Caffeine Alcohol Tobacco Theophylline Sympathomimetics Decongestants ECG Findings in PACs PAC's are the most common cause of a pause on ECG P [fprmed.com]

Supraventricular Tachycardia

Inverted P waves are sometimes seen after the QRS complex. These are called retrograde p waves. [acls-algorithms.com]

Upright retrograde P waves in aVR Inverted retrograde P waves lead II Example 5b The same patient following resolution of the AVNRT: Sinus rhythm. [lifeinthefastlane.com]

Retrograde P waves follow each QRS complex: upright in V1-3; inverted in II, III and aVF. [lifeinthefastlane.com]

Paroxysmal Supraventricular Tachycardia

Most patients present with palpitations and dizziness, and their electrocardiogram demonstrates a narrow QRS complex and regular tachycardia with hidden or inverted P waves [ncbi.nlm.nih.gov]

Upright retrograde P waves in aVR Inverted retrograde P waves lead II Example 5b The same patient following resolution of the AVNRT: Sinus rhythm. [lifeinthefastlane.com]

A distinguishing characteristic of orthodromic AVRT can therefore be an inverted P-wave (relative to a sinus P wave) that follows each of its regular, narrow QRS complexes [en.wikipedia.org]

Spontaneous Pneumothorax

An ECG was administered; findings indicated reversal of the arm leads (right axis deviation and inverted P waves in lead I), but there was no actual limb lead reversal present [ncbi.nlm.nih.gov]

Atrial Arrhythmia

wave morphology therefore differs from that of sinus rhythm) Atrial tachycardia with 2:1 block (note the inverted P waves) Multifocal atrial fibrillation Atrial tachycardia [ncbi.nlm.nih.gov]

[…] increasing block (flutter waves revealed after administration of adenosine) Atrial flutter with variable block Atrial tachycardia is initiated by an ectopic atrial focus (the P [ncbi.nlm.nih.gov]

Cardiomyopathy

There are some signs of left atrial enlargement — leftward deviation of the P wave axis (positive P waves in I and aVL, inverted in III and aVF) and prolongation of the terminal [lifeinthefastlane.com]

[…] portion of the P wave in V1. [lifeinthefastlane.com]

[…] an interventricular conduction delay mimicking LBBB — however, this is not LBBB as the morphology is not typical and there are small Q waves in V5-6 ( the presence of Q waves [lifeinthefastlane.com]

Paroxysmal Nodal Tachycardia

Because the retrograde conduction is via the fast pathway, stimulation of the atria (which produces the inverted P wave) occurs very soon after stimulation of the ventricles [en.wikipedia.org]

The RP interval is often so short that the inverted P waves may not be seen on the surface electrocardiogram (ECG) as they are buried within or immediately after the QRS complexes [en.wikipedia.org]

As a result, the time from the QRS complex to the P wave (the RP interval) is short, less than 50% of the time between consecutive QRS complexes. [en.wikipedia.org]

Acute Atrial Infarction

Abstract A patient with acute right ventricular infarction who showed hyposecretion of atrial natriuretic peptide (ANP) in spite of abnormally high right atrial pressure and who died of a severe low cardiac output syndrome is reported. Right atrial infarction, which was proven at autopsy, may be responsible for[…] [ncbi.nlm.nih.gov]

Atrioventricular Junctional Rhythm

There is no way that the SA node can fire off and produce an inverted P-wave. -An inverted P-wave does not mean ischemia.. [quizlet.com]

Retrograde inverted P waves with short PR intervals and a heart rate of 94/minute denotes to accelerated junctional rhythm. Click here for a more detailed ECG ECG 3. [metealpaslan.com]

If the P-wave is visible, it is ALWAY inverted in lead 2. [quizlet.com]

Patent Foramen Ovale

What Is a Patent Foramen Ovale? The foramen ovale (fuh-RAY-men oh-VAL-ee) is a normal opening between the upper two chambers (the right atrium and left atrium) of an unborn baby's heart. The foramen ovale usually closes 6 months to a year after the baby's birth. When the foramen ovale stays open after birth,[…] [kidshealth.org]

Atrial Tachyarrhythmia with Short PR Interval

Why do the ST segments and T-waves look so abnormal? This is just a result of a large and inverted, superimposed P-wave. [hqmeded-ecg.blogspot.com]

She was euthyroid; ECG revealed regular rhythm with inverted P waves, short PR interval, absent delta waves with normal QRS morphology ( Figure 1 ). [ncbi.nlm.nih.gov]

Diagnostic criteria include PR interval of no more than 120 ms, normal QRS complex duration, a normal or inverted P wave, and paroxysmal supraventricular tachycardia (PSVT [patient.co.uk]

Anomalies of Coronary Artery Origin

Prakash Suryanarayana, MD, 1 Shubha Kollampare, MD, 2 Mohammad Reza Movahed, MD 1,3 1 Department of Medicine, Division of Cardiology, University of Arizona School of Medicine, Tucson, AZ; 2 Department of Medicine, University of Arizona School of Medicine, Tucson, AZ; 3 CareMore Arizona, Tucson, AZ A single left[…] [read.nxtbook.com]

Dextrocardia

aka ‘global negativity’ (inverted P wave, negative QRS, inverted T wave) Absent R-wave progression in the chest leads (dominant S waves throughout) These changes can be [lifeinthefastlane.com]

[…] by, last update July 3, 2019 ECG Features of Dextrocardia Right axis deviation Positive QRS complexes (with upright P and T waves) in aVR Lead I: inversion of all complexes [litfl.com]

An inverted P wave in lead I is a reflection of atrial mirror reversal. [circ.ahajournals.org]

Lown-Ganong-Levine Syndrome

The criteria include a normal or inverted P wave, a short PR interval less than or equal to 0.12 second (120 ms), with normal QRS complex duration, the absence of a delta [symptoma.com]

Diagnostic criteria include PR interval of no more than 120 ms, normal QRS complex duration, a normal or inverted P wave, and paroxysmal supraventricular tachycardia (PSVT [patient.info]

She was euthyroid; ECG revealed regular rhythm with inverted P waves, short PR interval, absent delta waves with normal QRS morphology (Figure 1). [ncbi.nlm.nih.gov]

Cardiac Pacemaker Insertion

Abstract Diabetes mellitus increases the rate of atrioventricular block after a myocardial infarction; right bundle branch block is more common than expected in the diabetic outpatient population. We decided to assess whether diabetic subjects were more likely to need permanent cardiac pacemaker insertion. Data[…] [ncbi.nlm.nih.gov]

Basilar Artery Thrombosis with Occlusion of a Precerebral Artery

wave inverted', 'ECG signs of myocardial ischaemia', 'ECG signs of ventricular hypertrophy', 'echocardiogram abnormal', 'ejection fraction abnormal', 'ejection fraction decreased [definedterm.com]

', 'electrocardiogram p pulmonale', 'electrocardiogram p wave abnormal', 'electrocardiogram p wave biphasic', 'electrocardiogram pq interval prolonged', 'electrocardiogram [definedterm.com]

[…] venous pressure abnormal', 'central venous pressure decreased', 'central venous pressure increased', 'decreased ventricular afterload', 'decreased ventricular preload', 'ECG p [definedterm.com]

Supraventricular Tachycardia with Aberrant Conduction

This circuit conducts down the bundle of His (resulting in a narrow QRS) and generates retrograde conduction into the atria (inverted P waves buried within the QRS). [coreem.net]

There are numerous P waves, they are inverted: Note the arrows 2. [quizlet.com]

To remind everyone, p-waves need to meet the following criteria for the rhythm to be considered sinus: - a p-wave in front of every QRS - Normal p wave axis: upright in I, [everydayebm.org]

Preexcitation Syndrome

Therefore, a circuit is established, being seen as a tachycardia, with normal QRS but with inverted P waves (because of retrograde atrial activation). [web.archive.org]

Vagal Tone Increased

Note the inverted P waves that precede each QRS complex, with a rate of 115 bpm. [misc.medscape.com]

Note the inverted P waves that precede each QRS complex, with a rate of 115 bpm. Junctional bradycardia due to profound sinus node dysfunction. [misc.medscape.com]

Torsade-De-Pointes Syndrome with Short Coupling Interval

Example 4 Torsades de Pointes: Sinus rhythm, or possibly ectopic atrial rhythm (biphasic / inverted P waves in lead II). [lifeinthefastlane.com]

Cardiac Glycoside Poisoning

Electrocardiogram revealed inverted P wave in inferior lead and prolonged PR interval (.28 s), with varying degree AV blocks and normal QRS duration [Figure 1] and [Figure [heartviews.org]

P wave and prolonged PR interval .28 sec and in lead V2 intermittent 2:1 AV block 15 hours after the ingestion. [heartviews.org]

Electrocardiogram shows intermittent AV block 15 hours after the ingestion Click here to view Figure 2: Electrocardiogram in lead II (Top) shows first degree AV block with inverted [heartviews.org]

Situs Inversus

The only abnormalities appear to be the inverted P waves in the inferior leads. [eplabdigest.com]

[…] pulmonary stenosis or atresia, single ventricle, transposition of the great vessels, atrial septal defect, and ventricular septal defect. 2 Figure 1 shows a sinus rhythm with inverted [eplabdigest.com]

Electrocardiography (ECG) showed inverted p wave in lead I and positive QRS complex (Figure 2), positive p wave in lead avR, inverted p wave in avL and reverse progression [jmedicalcasereports.biomedcentral.com]

Conduction Disorder of the Heart

wave seen PAC: abnormally shaped P wave PJC: Narrow QRS complex, no p wave or inverted p wave Sick sinus syndrome Brady-tachy: Arrhythmia in which bradycardia alternates with [smartypance.com]

If ectopic pacemaker is localized in atrium on ECG inverted P wave is observed before QRS. [intranet.tdmu.edu.ua]

[…] in V4-V6 Right: R and R’ (upward bunny ears) in V1-V3 Paroxysmal supraventricular tachycardia Narrow complex tachycardia Premature Beats PVC: Early wide bizarre QRS, no p [smartypance.com]

Kartagener Syndrome

P waves in lead I abd there is reversed R-wave progression. [gpnotebook.co.uk]

Electrocardiogram (ECG) showed inverted “P” waves in L1 and AVL on left-sided chest leads (Figure 2). [panafrican-med-journal.com]

[…] recessive situs inversus is a developmental consequence of failure of ciliary action in the formation of the gastrointestinal tract and other stuctures in the ECG there are inverted [gpnotebook.co.uk]

Mesocardia

(inverted P wave, negative QRS, inverted T wave) Absent R-wave progression in the chest leads (dominant S waves throughout) References: 1. 1-Fuster V, Alexander RW, O'Rourke [bcs.com]

ECG- P wave axis is R and inf bc of atrial inversion -Dextrocardia w Situs Inversus, AV Concordance, & VA Discordance w Ao L & Ant -it's an inverted TGA (so morph LV is on [sites.google.com]

ECG features of dextrocardia include: Right axis deviation Positive QRS complexes (with upright P and T waves) in aVR Lead I: inversion of all complexes, aka global negativity [bcs.com]

Incessant Infant Ventricular Tachycardia

Figure 1 Case 1: 12 lead ECG showing permanent junctional reciprocating tachycardia with deep inverted P waves in inferior leads. [europace.oxfordjournals.org]

Therefore, a circuit is established, being seen as a tachycardia, with normal QRS but with inverted P waves (because of retrograde atrial activation). [patient.info]

PJRT: spontaneous termination of the tachycardia can occur with an inverted P wave followed by a pause 4.) [quizlet.com]

Premature Ventricular Contraction

This is visible on the ECG as an inverted P wave (“ retrograde P wave “), usually occurring after the QRS complex. [lifeinthefastlane.com]

If present, the P Waves may be positive (upright) or negative (inverted). If present, P Waves may precede, be buried in, or follow the QRS complexes haphazardly. [nurseslearning.com]

P Waves may be present or absent. If present, they do not have a set relation to the QRS complexes. [nurseslearning.com]

Bradycardia

This usually appears on an EKG with a normal QRS complex accompanied with an inverted P wave either before, during, or after the QRS complex.[5] An AV junctional escape is [en.wikipedia.org]

Wolff-Parkinson-White Syndrome

Therefore, a circuit is established, being seen as a tachycardia, with normal QRS but with inverted P waves (because of retrograde atrial activation). [web.archive.org]

Inverted P waves may be visible deforming the ST segment indicating that atrial depolarisation occurs later than ventricular depolarisation. [emj.bmj.com]

The QRS morphology is normal (that is, with no delta wave) during the arrhythmia because ventricular activation has occurred through the normal pathway. [emj.bmj.com]