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P Pulmonale (Right Atrial Enlargement)

P dextrocardiale, Right atrial hypertrophy, Right atrial abnormality, Delay of right atrial activation, Right atrial dilatation, Right atrial distention, Right atrial overload

Physiological P Wave

Schematic representation of normal P wave depolarization vectors

Cor Pulmonale and Right Atrial Abnormalities

Right atrial hypertrophy, abnormality, dilatation, distention, overload

P Pulmonale and Atrial Vector

Right atrial hypertrophy (P pulmonale) electrical vector
  • Cor Pulmonale
    • Is the most common cause of right atrial remodeling
  • The right atrium is enlarged
    • Thus, the right atrial vector (P1) will also be enlarged
  • Enlarged Atrium
    • Regardless of the etiology (cor pulmonale, regurgitation, myxoma)
    • It also creates a larger vector (P1)
  • On the ECG, the picture of P Pulmonale appears
    • P Pulmonale, because the most common cause is cor pulmonale
    • ECG does not differentiate the etiology of "atrial enlargement"

P Pulmonale and Lead II

P pulmonale (tall and symmetrically peaked P wave) in frontal plane ECG II lead

P Pulmonale and Lead II


P Pulmonale and Lead V1

P pulmonale (biphasic) in horizontal plane, lead V1

P Pulmonale and Lead V1

  • Lead V1 "looks at" the atrial vectors in the horizontal plane
  • The atria depolarize sequentially:
    • First, the right atrium depolarizes (more pronounced P1 vector points towards V1)
    • Then the left atrium depolarizes (P2 points away from V1)
  • In P Pulmonale, the depolarization of the right atrium lasts longer and the P1 vector points towards V1
  • The P wave will be biphasic in V1, because:
    • P1 points towards V1
    • P2 points away from V1
    • The P1 vector is more pronounced
      • Therefore, the first part of the biphasic P wave will be high

ECG and P Pulmonale

ECG P Pulmonale (symmetrically peaked P wave) in lead II ECG P Pulmonale (biphasic) in lead V1

Normal P Wave and P Pulmonale

Normal heart atrial size
ECG lead II P wave with normal atrial size

ECG lead V1 P wave with normal atrial size

Normal P Wave

  • In a normal P wave, the atria are not enlarged
  • Evaluate in leads II and V1


P pulmonale vs. normal P wave
ECG P pulmonale, dextrocardiale

ECG P pulmonale, right atrial abnormality, dilatation, overload

P Pulmonale



ECG P pulmonale morphology. Lead II (tall symetrical P wave), Lead V1 (biphasic P wave)

P Pulmonale

  • Lead II
    • High P wave
    • Amplitude > 2.5mm
  • Lead V1
    • First part of the P wave > 1.5mm (amplitude)
    • Area of the first part > 1 small square


ECG criteria right atrial enlargement (P pulmonale), peaked P waves in lead II

P Pulmonale



ECG p pulmonale (dextrocardiale)

P Pulmonale

  • P wave amplitude > 2.5mm in Lead II (also in other lower leads III, aVF)


ECG cor pulmonale, P pulmonale, right ventricular hypertrophy, righ axis deviation, righ bundle branch block

Cor Pulmonale (P Pulmonale + Right Ventricular Hypertrophy)




Sources

  • ECG from Basics to Essentials Step by Step
  • litfl.com
  • ecgwaves.com
  • metealpaslan.com
  • medmastery.com
  • uptodate.com
  • ecgpedia.org
  • wikipedia.org
  • Strong Medicine
  • Understanding Pacemakers





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Home /

P Pulmonale (Right Atrial Enlargement)

P dextrocardiale, Right atrial hypertrophy, Right atrial abnormality, Delay of right atrial activation, Right atrial dilatation, Right atrial distention, Right atrial overload

Physiological P Wave

Schematic representation of normal P wave depolarization vectors

Cor Pulmonale and Right Atrial Abnormalities

  • Pulmonary Hypertension
  • Tricuspid Stenosis
    • Causes pressure overload of the right atrium
    • The right atrium pumps blood through a stenotic (narrowed) tricuspid valve
    • Leads to right atrial hypertrophy
  • Tricuspid Regurgitation
    • Causes volume overload of the right atrium
    • During systole of the right ventricle, blood regurgitates into the right atrium
    • Leads to dilatation of the right atrium
  • Atrial Myxoma
    • A myxoma is a benign tumor of connective tissue
    • Very commonly occurs in the atria of the heart
 Right atrial hypertrophy, abnormality, dilatation, distention, overload

P Pulmonale and Atrial Vector

  • Cor Pulmonale
    • Is the most common cause of right atrial remodeling
  • The right atrium is enlarged
    • Thus, the right atrial vector (P1) will also be enlarged
  • Enlarged Atrium
    • Regardless of the etiology (cor pulmonale, regurgitation, myxoma)
    • It also creates a larger vector (P1)
  • On the ECG, the picture of P Pulmonale appears
    • P Pulmonale, because the most common cause is cor pulmonale
    • ECG does not differentiate the etiology of "atrial enlargement"
 Right atrial hypertrophy (P pulmonale) electrical vector

P Pulmonale and Lead II

P pulmonale (tall and symmetrically peaked P wave) in frontal plane ECG II lead

P Pulmonale and Lead II


P Pulmonale and Lead V1

P pulmonale (biphasic) in horizontal plane, lead V1

P Pulmonale and Lead V1

  • Lead V1 "looks at" the atrial vectors in the horizontal plane
  • The atria depolarize sequentially:
    • First, the right atrium depolarizes (more pronounced P1 vector points towards V1)
    • Then the left atrium depolarizes (P2 points away from V1)
  • In P Pulmonale, the depolarization of the right atrium lasts longer and the P1 vector points towards V1
  • The P wave will be biphasic in V1, because:
    • P1 points towards V1
    • P2 points away from V1
    • The P1 vector is more pronounced
      • Therefore, the first part of the biphasic P wave will be high

ECG and P Pulmonale

  • Enlarged right atrium
    • Regardless of etiology (hypertrophy, dilation, myxoma)
    • Creates the image of P Pulmonale
  • The P wave is evaluated in leads II and V1
    • Because these leads "view" the atria from the best angle

  • Lead II (P Pulmonale)
    • Amplitude > 2.5mm
    • This "tall" P wave in lead II is specifically referred to as P Pulmonale

  • Lead V1 (P Pulmonale)
    • First positive part > 1.5mm
    • Area of the first part > 1 small square
ECG P Pulmonale (symmetrically peaked P wave) in lead II

ECG P Pulmonale (biphasic) in lead V1

Normal P Wave and P Pulmonale

Normal heart atrial size ECG lead II P wave with normal atrial size ECG lead V1 P wave with normal atrial size

Normal P Wave

  • In a normal P wave, the atria are not enlarged
  • Evaluate in leads II and V1


P pulmonale vs. normal P wave ECG P pulmonale, dextrocardiale ECG P pulmonale, right atrial abnormality, dilatation, overload

P Pulmonale



ECG P pulmonale morphology. Lead II (tall symetrical P wave), Lead V1 (biphasic P wave)

P Pulmonale

  • Lead II
    • High P wave
    • Amplitude > 2.5mm
  • Lead V1
    • First part of the P wave > 1.5mm (amplitude)
    • Area of the first part > 1 small square


ECG criteria right atrial enlargement (P pulmonale), peaked P waves in lead II

P Pulmonale



ECG p pulmonale (dextrocardiale)

P Pulmonale

  • P wave amplitude > 2.5mm in Lead II (also in other lower leads III, aVF)


ECG cor pulmonale, P pulmonale, right ventricular hypertrophy, righ axis deviation, righ bundle branch block

Cor Pulmonale (P Pulmonale + Right Ventricular Hypertrophy)




Sources

  • ECG from Basics to Essentials Step by Step
  • litfl.com
  • ecgwaves.com
  • metealpaslan.com
  • medmastery.com
  • uptodate.com
  • ecgpedia.org
  • wikipedia.org
  • Strong Medicine
  • Understanding Pacemakers