Pathological Signs

Question 1

What makes a Q wave pathological?

Answer 1

• WIDTH: greater than 0.04 seconds (1 small box) wide
• HEIGHT: greater than 2mm deep (2 small squares)
• PROPORTION: Greater than 25% the height of the R wave

LOCATION: often pathological

Often associated with MYOCARDIAL INFARCTION

Question 2

What makes a P wave pathological?

Answer 2

• DURATION: over 120ms (3 small boxes)

ABNORMAL SHAPE: peaked or notched P waves

Absent P waves is pathological in most leads

Question 3

What can a peaked P wave suggest?

Answer 3

A P wave with an amplitude greater than 2.5mm in the inferior leads (like lead II) suggests right atrial enlargement, often seen in pulmonary hypertension or cor pulmonale. This is referred to as P pulmonale.

Question 4

What can a notched P wave suggest?

Answer 4

A notched P wave, especially with a peak-to-peak distance of over 0.04 seconds (one small box on the ECG grid), can indicate left atrial enlargement, potentially due to mitral stenosis or other conditions affecting the mitral valve.

Question 5

What can inverted P waves suggest?

Answer 5

Inverted P waves can occur in certain rhythms, such as atrial fibrillation, or may be associated with right atrial enlargement.

Question 6

What makes a T wave?

Answer 6

• T wave inversion ~ sign of Myocardial Ischaemia , infarction or ventricular strain
• talk and ‘peaked T wave’ ~ often a sign of Hyperkalaemia
• Broad or notched T waves ~ common in long QT syndrome

T WAVE INVERSION IS NORMAL IN LEADS:

• aVR
• V1
• III