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NurseElisa
NurseElisa, LPN
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I have inverted p waves on my EKG. Do I need to be ...

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I have inverted p waves on my EKG. Do I need to be concerned? My blood pressure is great, I'm in good health.
Submitted: 7 years ago.
Category: Health
Expert:  NurseElisa replied 7 years ago.
If the P waves are upright in leads II and AVF of the ECG, they have originated from the sinoatrial node, which is the normal pacemaker of the heart, located in the atrium or top chamber of the heart. However, if the P waves are inverted in leads II and AVF, it indicates that the atria are being activated in a retrograde direction ie: the rhythm is junctional or ventricular, not being stimulated by the heart's normal pacemaker (the sino-atrial or SA node).

Some people have a congenital (upon birth) block of the atrium. It would be important to know what previous ECG's look like and if it was always present.

My husband has two electrical blockages in his heart that he was born with. It was only picked up on a routine ECG and my husband has never had symptoms.

Your concern should be to follow up with a cardiologist every six months to a year and for him to monitor changes. Some cardiologists may want to do an echocardiogram to make sure the valves of the heart and the ventricles of the heart are functioning normally and that there are no tumors in the heart. Yes, tumors in the heart do happen. But not necessarily in a case where a "P" wave is inverted. However, doctors like to play it on the safe side. An echocardiogram is simply a sonogram of the moving heart.

Some cardiologists also like to perform a stress test. Not so much in your case to simulate stress to bring on chest pain, but to observe the heart in action when your heart beat is raised. This gives them indications of where exactly signals are coming from in your heart and if these signals are strong enough to contract the whole heart (myocardium - the heart muscle).

This in no way means your arteries to your heart are blocked. It means your heart signals to contract by a way other than the heart's normal pacemaker.

The worst case scenario, down the line, may be the need of a permanent pacemaker implanted. You would have gradual signs of needing this - you may feel lightheaded if you are doing something that is supposed to increase your heart rate, you may have a slowing of your pulse, you may have a feeling like you might pass out. These are not sudden symptoms. And this may not happen to you at all! My husband is in his early sixties and only twice did he have symptoms - and they went away right away. Once he picked up a 600 lb. boat motor on a 100 degree day, carrying it about 120 feet. He became short of breath and lightheaded. His pulse did not speed up to meet his oxygen requirements (his pulse stayed at 80 beats per minute), but he recovered within 2 minutes of rest. The other time this happened to him was when a doctor was inserting a needle into a badly infected knee joint without the use of a local anesthetic. He was on a heart monitor - his normal pulse was 70 and it never went beyond 88 when he was in excruiating pain (a normal pulse would have been 110 to 120's with a normal person). He passed out for a couple of seconds and then woke up without the need of further medical intervention.

It's something to keep an eye on. That's it.

Hope this helps!


NurseElisa, LPN
Category: Health
Satisfied Customers: 666
Experience: 30 years, critical care, home care, management, coronary care, gastroenterology, sex!
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Customer: replied 7 years ago.
Reply to NurseElisa's Post: You are correct, this is something that has always shown up on my EKG and I have had several stress EKGs for my past job with no red flags by any of the physicans. My new employer is now questioning the signficance of it and it is un-nerving.
Expert:  NurseElisa replied 7 years ago.
Congenital baby. They are looking for a history of a heart attack. You can have a doctor provide a prescription that says "congenital" (born with it).

We've been down that road too with health insurance companies refusing to pay because my husband didn't disclose he had a heart attack. Same thing with life insurance.

Unfortunately, companies, including health insurance companies don't hire nurses, doctors or medically knowledgeable people anymore. They hire experts who know how to push papers around.

You're going to have this brought up time and time again in your life. I always keep a copy of all my husband's ECG's and stress tests in the house in a folder in case we need them.

I'm glad you had all that work-up too. This definitely puts to rest that this is a congenital issue that is not dangerous by itself. Your heart is perfectly healthy otherwise. Everyone else needs to get their acts together!

Take care!


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