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P wave changes?
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P wave changes?

Does anyone know anything about what causes P wave changes on an EKG? I still haven't found anything about this and Is_something_wrong reminded me in my other question and what do I do? forget to ask at the dr's...

I asked a question in the HD forum recently and we were discussing HF etc and this came up.  I asked in the HD forum also because I don't know if this has something to do with the structural changes in my heart or if it's just an electrical problem.
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17 Comments Post a Comment
Avatar f tn
Not sure if its what you are looking for --but I will send you the links I found with info on p-wave-just a sec.
967168 tn?1343732745
thanks I got them, not sure I can read or understand them lol but I'm keeping the links for later on so hopefully I'll get to read them
995271 tn?1463927859
Do you know what the changes are?  Did they get longer, shorter, invert, stop?
967168 tn?1343732745
Examples:   my  P-R-T axis have been - (I think that's what you're asking?)
4/27/2007         58 80 63
11/28/2008       12 53 22
6/25/2009         61 59 29
6/25/2009         63 59 34
7/14/2009         81 84 68
7/26/2009         61 56 36
8/26/2009         70 74 43
8/27/2009         30 56 19
8/28/2009         56 70 42
1/15/2010         26 61 26
995271 tn?1463927859
I'm pretty sure, but not completely, the PRT axis analysis you are showing me here has nothing to do with P wave changes.  What your PRT axis #s here shows that things are within normal ranges.  PRT axis measurements are used to attempt to detect poor blood flow to the heart heart's arteries.

I'm pretty sure what you're showing me here has nothing to do with P wave changes, but I could be wrong.

Where did you see "P wave changes"?  was it the EKG machine report or on the doc's report?
967168 tn?1343732745
Itdood, ummm I have no clue then lol I was told by someone (I can't remember the name here - nurse who reads ekg's) that in 2010 when they read my ekg's; then Is_something_wrong mentioned it in a PM and in the heart disease expert forum when I asked the dr there about HF/CHF.

http://www.medhelp.org/posts/Heart-Disease/CHF-or-HF/show/1449978 By the way (you know I'm just a stupid EKG nerd and no doctor ;) have you asked your doctor why the P waves in your EKG keeps changing? I can see from your first normal EKG your P wave axis was 12 degrees, and it changes to >80 degrees in the later EKGs. Are you sure you are in sinus rhythm at all times (or a possible atrial ectopic rhythm that may origin close to the SA node)? Or some changes in the atrias that may indicate something?

I can't find anything on it and forgot to ask my dr; but going to ask when I go back I just wanted to see if anyone knew why this would happen so I would know what to ask him and what he was talking about when I go in =)
1124887 tn?1313758491
You probably know this, but let's just give an example.

In the limb leads (I,II,III, aVL, aVF, aVR) you have the following axis:

aVL = -30 degrees
I = 0 degrees
-aVR (if using the Cabrera setup) 30 degrees
II = 60 degrees
aVF = 90 degrees
III = 105 degrees

In other words, if the main vector is 90 degrees, the impulse is likely to origin high and in the middle of the heart. If so, aVF will give the largest positive P wave and I will be isoelectric.

Normal P waves are 0 to 75 degrees, and it depends much on LA and RA dimensions. But I didn't think they should change so much as 12 to 81 degrees.

If you see a P wave from a PAC (if visible and not mixed with the previous T wave) it's often negative in I and II, which is a sign that the PAC origin in LA, travelling backwards, towards the sinus node, with an axis of, say, 150-180 degrees. If the axis is positive, the impulse origin in RA but not necessarily in the sinus node.

My suspicion (that may, of course, just be rambling) was that Lisa isn't always in a normal sinus rhythm if the atrial axis keeps changing. But of course, a MD must confirm (or most likely rule out) this. I'm just throwing ideas on the table, because this diagnosis is a mystery and maybe one of us, one day, can throw out something a MD can work further with, possibly solving the mystery.

1124887 tn?1313758491
Sorry, change the "if the axis is positive" to "if the axis is 0-90 degrees" :)
967168 tn?1343732745
oh that is WAY above anything in my realm of understanding lol I know the nurse i asked in 2010 (I wish I could remember the name but I can't) said something about it also and about aortic stenosis I believe it was, but I just can't remember.

even with all my problems, what could cause me to be out of NSR? is that the million dollar question we're trying to find or that's just part of the equation?

luckily I'll have a new echo in a couple of weeks, I'm hoping that will yield some new answers...

one question - is Fractional Shortening something to worry about? I know mine is 18% if you go by the LVEDD - LVESD/LVEDD = FS method, what causes FS to be low? I was reading about DD and found this info but not much else about it.
1124887 tn?1313758491

I got familiar with the term Fractional Shortening after my last echo.

FS is almost the same as EF, but calculated in one dimension (as you know, the heart is three-dimensional ;)

If your LVEDD is 5 cm and your LVESD is 4 cm, your FS is 5-4/5 = 20%. If the heart was a cube, the EF would be 5^3 - 4^3 / 5^3 = (125-64/125) = 48%.

The heart is not a cube, so the calculation is not correct. In addition, some parts of the heart may contract better than others.

My cardiologist said that EF = FS x 2 (roughly). I think it underestimates at low FS and overestimates at high FS. My FS was 40% and my EF was somewhat below 80%, probably 75-80.

1124887 tn?1313758491
By the way, did you ever capture the start of one of your arrhythmias on EKG?

If they are caused by early PVCs, one could suspect LQTS or some other ion channel problems (except the scary 4 letter acronym that I won't mention). If they are caused by rapid heart rate and exercise, searching for ARVD, CAD, the 4 letter acronym that I won't mention, though extremely unlikely, myocarditis and other cardiomyopathies could possibly help?

If they are caused by bradycardia, ANS dysfunction and/or sinus node dysfunction could be suspected?

(I'm guessing here, this is really far above my knowledge)..
967168 tn?1343732745
Is_something_wrong that makes sense, my FS would be 36 if calculated by that method and my Cath said 40% so pretty close.

The ekg's in my profile are the only ones I have, I have asked the hospital over and over for them all and they sent me only 3, even though I asked specifically for the ones during surgery and they say there aren't any. I don't buy it.  

I would like to find the one during my stress treadmill test but the cardiologist said they didn't have one either, even though I was hooked up to the ekg machine. My stress test shows the problems I have with exertion.

I'm lost...what 4 letter word? VFib? why not mention it...if not VFib what else - my brain hurts just trying to think of 4 letter words lol Don't think I had Vfib outside of surgery but who the heck knows...I did have 2 or 3 episodes in Jan & Feb 2009 that were different than my normal pvc's while we were out walking, but that's just guessing.

I asked about LQTS because one ekg said proglonged QT with multifocal pvc's; but then again I do have VT's and had them since I was young.  I've fainted too many times to count with rapid hr's both at rest and exercise.

CAD has been ruled out thankfully =) because of my cardiac cath.

Even though I mentioned Group B Streptococcus that I had in 1997, they dismissed my concerns and said it had been too long for myocarditis.  I think with Cardiomegaly they should have at least looked into it; but it could mimic something else such as Sarcoidosis as the dr in the expert forum said.

I do have CM which might have been in there all along and just worsening over time...maybe?   I do have alot of symptoms of it - but here again...I have symptoms that mimic alot of things that they said was due to my ANS...maybe not? I still question the protocol for the TTT and about the test itself.

I really wonder how much GBS in 1997 plays a part of my problems. It turned septic and did a number on my body & system.  Still more questions and not enough answers.  

Here's what I showed my dr's and just added in my symptoms after 2009. http://www.medhelp.org/user_journals/show/266864/Documented-Symptoms
1124887 tn?1313758491
The 4 letter word is CPVT. I can feel my BP rise to the 150s just by writing it. I really hate that word, lol.

Well, to start looking, you describe polymorphic VT induced by programmed stimulation. As you know, there are more than one polymorphic VT. I'm not familiar with all of them, but I think you can have some sort of "standard" polymorphic VT that is like a "light" V-fib, seen with cardiomyopathy and CAD, where the entire heart muscle is irritable and starts firing PVCs, you can have TdP and you can have bidirectional VT. I think TdP is the hallmark sign of LQTS and bidirectional VT is common with the 4 letter word and some other conditions (I think the most common is digitalis intoxication).

Remember, myocarditis can start a slow process of dilating the heart.

I think you just need to find a cardiologist (or a team of cardiologists) that can rule out the conditions, one by one. If you can't get your blood pressure above 150/90 with heavy exercise, something is definitely not right. You've had severe infections and ANS disorders, which both can affect the heart heavily. Maybe they both are to blame.

I guess it's hard to rule out ARVD too, but again, a cardiologist who specializes in this should answer. But I'm not sure if ARVD causes LV dysfunction or PVT.

lol, again, I'm not getting any closer to the problem. Maybe it's a good idea to visit a major heart hospital with several cardiologists. Is that covered by your insurance?

995271 tn?1463927859
Yea I saw there was a wide range on the P axis.  The standard D was something like 22 so there is variation.

To be honest I have no idea what the clinical signifiance of that is or if it's even abnormal.  I mean the values are all in range, I just have no idea if a change in axis from EKG to EKG is significant.   That could be as simple as lead placement issues, think about it, the leads aren't going to be in the same exact spot from EKG to EKG.    From what I know of measrung PRT axis it's reliant on signal timing from lead to lead so lead placement can cause variance.

I google searched a lot for the issue, the only other info I could find was on different medical board where it looks like your post lisa, posted under the ID of "InShock".  Soooo, there's not a whole lot of chatter in the ether about this type of finding.  
967168 tn?1343732745
ahhh oh yeah I remember looking up that bad 4 letter word too...

I just found a great new cardiologist and he's going to get with some other dr's and pick apart my case and try to figure this all out - he referred me to Vanderbilt University so they can do all the autonomic testing and get some clearer answers and see what the cardiologists there say.

I have to go to an Endocrinologist and Rheumatologist along with my Neurologist so hopefully in the next few months I'll have some answers =)
967168 tn?1343732745
I won't ask there again, had no idea I had posted before but they told me NOT to post about the same thing again...even though it was different things...can't figure out how to delete my posts there either or I would...they have their panties in a wad on that site lol sorry if that's not allowed.

Itdood that's what I kind of figured, what's the likely hood with the same equipment, same nurse 3 days in a row with different readings like when I was in the hospital? I don't know a p wave from a T wave but 2 separate people asking about p wave variations was weird
967168 tn?1343732745
sweet i figured it out, I wish I could manage my posts here also =)
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