Chapter 5 Test — The P Wave: Atrial Activity & Enlargement

In an ECG recording, the P wave is produced by:

The figure models the P wave as two overlapping components. In lead V1, the normal P wave is biphasic — an initial positive deflection followed by a terminal negative deflection. The terminal negative component of the P wave in V1 is produced by:

Chronic right atrial overload is indicated on the ECG by a P wave amplitude in lead II of more than:

A 67-year-old man with a history of COPD presents with 2 weeks of worsening dyspnoea and bilateral pedal oedema. His ECG lead II shows a tall, peaked P wave exceeding 2.5 mm in amplitude with a normal P-wave duration. Which of the following best explains this ECG finding?

The lead II rhythm strip shown demonstrates tall, peaked, narrow P waves of normal duration. Which of the following conditions most characteristically produces this P-wave appearance?

A wide and notched (M-shaped) P wave in the limb leads is typically seen in:

In lead V1, the terminal negative component of a patient's P wave measures 2 mm deep and 50 ms wide. Which of the following correctly states the P terminal force (PTF) and its interpretation?

A 58-year-old hypertensive woman is seen for palpitations. Her ECG shows a broad, notched P wave in lead II (as shown) with a duration of 130 ms, and a P terminal force in V1 of −0.06 mm·sec. She is otherwise asymptomatic. She is at significantly increased risk of developing which of the following?

A 72-year-old man is investigated for recurrent palpitations and a previous transient ischaemic attack. His ECG shows a P-wave duration of 140 ms with a biphasic (positive-then-negative) P wave in leads II, III and aVF. Echocardiography reports a normal left atrial size. What is the most likely diagnosis?

A 63-year-old man with long-standing rheumatic heart disease presents with orthopnoea. His P wave in lead II measures 3 mm in amplitude and 140 ms in duration, and in V1 there is a tall initial positive deflection followed by a deep terminal negative deflection — the pattern shown in the bottom row of the figure. What is the most appropriate next step?

A patient in a regular rhythm has absent P waves on the ECG. Leads II, III and aVF reveal a sawtooth pattern. Which of the following is the most likely diagnosis?

The 12-lead ECG shown demonstrates a regular narrow-complex tachycardia with no discernible P waves. You suspect AVNRT and want to find the buried retrograde P waves. Where should you look?

A 70-year-old man with an acute COPD exacerbation is hypoxic (SpO₂ 86% on room air). His ECG shows an irregular tachycardia at 125/min with at least three distinct P-wave morphologies and varying PR intervals, confirming multifocal atrial tachycardia. What is the most appropriate management?

The rhythm strip shown is from a 24-year-old asymptomatic competitive athlete. The rhythm is slightly irregular at 72/min, and there are at least three different P-wave morphologies with varying PR intervals, each P wave conducting to a narrow QRS. What is the most likely diagnosis?

The tracing shows abnormal P waves (arrows) preceding every QRS complex. On the full 12-lead ECG these P waves are inverted in leads II, III and aVF, the rate is 68/min and the PR interval measures 140 ms. What is the most likely rhythm?

A 40-year-old asymptomatic man has a routine ECG. The P wave is upright in aVR and inverted in lead I. The precordial leads show entirely normal R-wave progression from V1 to V5. What is the most likely explanation?