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11 Possible Causes for Inverted P Wave, Patient Appears Acutely Ill

  • Supraventricular Tachycardia

    Inverted P waves are sometimes seen after the QRS complex. These are called retrograde p waves.[acls-algorithms.com] waves may be non-identifiable, especially when the ventricular rate is high If P waves are present, they will likely be inverted in leads II, III, and aVf QRS complex duration[medictests.com] […] in infants and 180 bpm in children Non-variable R-R waves The rhythm will be consistently regular (because associated AV block is extremely rare in infants/children) The P[medictests.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] P waves in leads II, III, aVF, V 3 -V 6 Rare: References: [1] [3] [4] Pathophysiology AVRT Do not confuse atrioventricular reentrant (or reciprocating) tachycardia ( AVRT[amboss.com] […] impulse is conducted in a retrograde fashion from the ventricles to the atria by a concealed accessory pathway orthodromic AVRT ECG : similar to orthodromic AVRT but with inverted[amboss.com]

  • 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]

  • 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]

  • Atrial Flutter

    Retrograde atrial conduction produces: Inverted flutter waves in leads II,III, aVF Positive flutter waves in V1 – may resemble upright P waves Clockwise Reentry.[lifeinthefastlane.com] Here is an example of smaller P waves seen in between the QRS complexes: Can you see the P waves? They are upside down (inverted) in this example.[teachingmedicine.com] There are inverted flutter waves in II, III aVF at a rate of 300 bpm (one per big square) There are upright flutter waves in V1 simulating P waves There is a 2:1 AV block[lifeinthefastlane.com]

  • Acute Cor Pulmonale

    The most typical ECG findings in emphysema are: Rightward shift of the P wave axis with prominent P waves in the inferior leads and flattened or inverted P waves in leads[lifeinthefastlane.com] Peaked P waves in the inferior leads 2.5 mm (P pulmonale) with a rightward P-wave axis (inverted in aVL) Clockwise rotation of the heart with a delayed R/S transition point[lifeinthefastlane.com]

  • Tachyarrhythmia

    waves, fixed P-R interval: sinus tachycardia Multiform P waves, variable P-R interval: MFAT Inverted P waves: AV nodal tachycardia Sawtooth P waves: A-flutter No atrial activity[openanesthesia.org] Because the atrial and ventricular depolarisations occur virtually simultaneously the p waves are often buried within the QRS complexes on the ECG.[fastbleep.com] […] sinus tach, also consider A-flutter with fixed (2:1, 3:1…) AV block Rhythm regular, pulse 150: AV nodal re-entrant tachycardia (aka PSVT) Then look at the atria: Uniform P[openanesthesia.org]

  • Acute Pericarditis

    PTa depression (depression between the end of the P-wave and the beginning of the QRS- complex) stage II: pseudonormalisation (transition) stage III: inverted T-waves stage[en.ecgpedia.org]

  • Post-Infarction Pericarditis

    PTa depression (depression between the end of the P-wave and the beginning of the QRS- complex) stage II: pseudonormalisation (transition) stage III: inverted T-waves stage[en.ecgpedia.org] In the study, 19 patients were operated on for FWR, but these patients did not appear to do better than patients who did not undergo surgery.[circ.ahajournals.org] However, this may be due to a severe bias because acutely ill patients may be sent to surgery more often.[circ.ahajournals.org]

  • Cor Pulmonale

    The most typical ECG findings in emphysema are: Rightward shift of the P wave axis with prominent P waves in the inferior leads and flattened or inverted P waves in leads[lifeinthefastlane.com] Physical examination The patient may appear acutely ill with severe dyspnea at rest and visible peripheral edema.[medical-dictionary.thefreedictionary.com] The electrocardiogram evidenced sinus rhythm with 100 bpm, peaked P wave and inverted T wave from V1 to V3.[scielo.br]

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