McGill EKG Learning Project

You are seeing Ms. F in the Emergency Room. She is a 55 year old woman with a 30 pack year history of smoking who has presented with increasing cough and shortness of breath.

Rate	75-100
Rhythm	Regular. P waves present.
Axis	Normal
Conduction	Each P wave is followed by a QRS. PR < 0.2s. QRS < 0.12s
Hypertrophy	Possible LVH Evidence for RAE in lead II.
Infarction	T waves upright. ST segments normal. No Q waves

Discussion

This patient has tall, peaked p waves in lead II. It is a classic EKG pattern called P Pulmonale associated with Right Heart strain. In a patient with a history of smoking, a COPD exacerbation is a likely cause. Remember to look at the shape of the p waves as part of a systematic interpretation. The ST changes in V2-3 are benign. On close inspection, the J point is well defined and doesn't appear to be elevated.