Cardiac Rhythms

Step 3 P wave Morphology (Shape) ECG Interpretation

Description

The lead most commonly referenced in cardiac monitoring is lead II.
For the purposes of this training module, lead two will specifically be referenced unless otherwise specified.
The P wave in lead II in a normal heart is typically rounded and upright in appearance.
Changes in shape must be reported. This can be an indicator that the locus of stimulation is changing or the pathway taken is changing.
P waves may come in a variety of morphologies i.e. rounded and upright, peaked, flattened, notched, biphasic (second complex, pictured), inverted and even buried or absent!
Remember to describe the shape. This can be very important to the physician when diagnosing the patient.

Analyze this tracing. Describe the P waves.

Reveal Answer

Upright and uniform

Analyze this tracing. Describe the P waves.

Reveal Answer

Variable, upright, inverted and absent

Authors and Sources

Electrocardiography for Healthcare Professionals, 6th Edition Kathryn Booth and Thomas O'Brien
ISBN10: 1265013470, ISBN13: 9781265013479
McGraw Hill, 2023
Rapid Interpretation of EKG's, Sixth Edition
Dale Dublin
Cover Publishing Company
EKG Reference Guide
EKG.Academy
12 Lead EKG for Nurses: Simple Steps to Interpret Rhythms, Arrhythmias, Blocks, Hypertrophy, Infarcts, & Cardiac Drugs
Aaron Reed
Create Space Independent Publishing
Heart Sounds and Murmurs: A Practical Guide with Audio CD-ROM 3rd Edition
Elsevier-Health Sciences Division
Barbara A. Erickson, PhD, RN, CCRN
The Virtual Cardiac Patient: A Multimedia Guide to Heart Sounds, Murmurs, EKG Jonathan Keroes, David Lieberman
Publisher: Lippincott Williams & Wilkin)
ISBN-10: 0781784425; ISBN-13: 978-0781784429
Project Semilla, UCLA Emergency Medicine, EKG Training Breena R. Taira, MD, MPH
ECG Reference Guide
PracticalClinicalSkills.com