Identifies a specific P wave morphology (widened, low voltage, bifid or flat-topped) as a potential electrocardiographic sign of left ventricular failure in hypertensive heart disease.
May flag LV failure on ECG in hypertensive patients; hypothesis-generating and requires prospective validation before practice change.
The prominent P wave associated with mitral stenosis is well recognized it is usually widened and is often notched, bifid, or flat-topped ; it is generally thought to be a result of left auricular hypertrophy. There is also some evidence that a tall spiked P wave may be produced by right auricular hypertrophy, for such a wave is rarely found except in cases of tricuspid stenosis," congenital pulmonary stenosis, and chronic cor pulmonale. It is the purpose of this communication to draw attention to a third type of P wave which we have found to be commonly associated with hypertensive heart disease, especially when there is left ventricular failure. This P wave is widened and of low voltage ; it is also usually bifid or flat-topped. Typical examples of these three types of P wave are shown in Figs. . FIG. 1.Prominnt bif and wdened Pwave i a 7ae fmtrlsenss
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Wood et al. (1939) studied this question.
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