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Double 'P' waves?!?


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The chances of her having a true LBBB, or an MI for that matter, are slim.

Spoken like a man who knows a thing or two about Slim! :lol:

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God i love this site, Shane thanks for the refresher as well ER Doc. Did u do a stroke test on her...........no smart coments :oops: as a pre sycope????? could this be a sign of a possible CVA in the works, smoker???? drink??? meds legal or not birth control etc. Interesting.

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Sorry gang, got sidelined in the E/R for a couple days. Still recovering so replies could be slow.


Neuro checks were all good, no hx of CVA :wink: , no predisposition except for smoking (<1 pk/day) and social drinker. No meds, rec or rx. If memory serves me correct she possibly had a vagal response after having a BM, but details are getting a little foggy though and my partner couldn't shed any more light on it. I also checked the LP-12 archives and it appears to have been bumped already (sorry).

I'm wonderin if we just stumbled on an interatrial block and it had us befuddled... until Shane & ERDoc pointed me in the right direction. On top of that I learned a thing or two about biphasic P-waves and p-mitrale while I was at it!

I think I'll file the PID dx for something anatomically lower, maybe cranial-rectal inversion syndrome, and a slightly modified treatment plan (we don't have the luxury of helo evac).

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  • 4 weeks later...

That sounds like a P wave with a PR interval prolongation, if you think of a junction being blocked [a short escape interval] then the next junction or conducted P wave would be shorter due to the block in the escaping QRS complex, and in turn a shorter PR interval. Ending up with two P waves, at the “R” junction blockage.


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Isn't that pretty much what an interatrial block is?

BTW: You better slow down on your education... you get many more letters after your name & you'll have to get your own alphabet!

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  • 4 months later...

Sorry to dig up a dead post, but somehow I got to thinking about this. Another cause of multiple P waves is a heart transplant. When they remove the old heart, they leave in old SA node. The new heart comes with a new SA node. So, you get two p waves.

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