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Chapter 12: Abnormalities of the P Wave

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Chapter 12: Abnormalities of the P Wave

The P waves represent atrial depolarization. In a diseased heart, the P wave aberrations in sinus rhythm do not indicate a more serious cardiac condition compared to the aberrations in the QRS complex. However, the P waves can provide some information regarding changes in the hemodynamic state of the diseased heart, especially if the P wave is associated with abnormalities in the QRS complexes. 

Left and right atrial enlargement are caused by a chronic overload in the atria that leads to hypertrophy and dilatation. Abnormalities in the P wave are commonly attributed to atrial enlargement. However, other diseases also affect the P wave.

When describing ECG characteristics of patients with left and right atrial enlargement, the terms P mitrale, P pulmonale, and P biatriale are commonly used.

  • P mitrale: ECG findings representing left atrial enlargement 
  • P pulmonale: ECG findings representing right atrial enlargement 
  • P biatriale: ECG findings representing bilateral atrial enlargement