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Patient
Young woman 23 years of age, asymptomatic, with no prior history and a normal cardiac ultrasound;
Trace
Sinus rhythm with a rate of 56 bpm; normal P-wave: positive in leads I, II, V5, V6 and negative in aVR; normal P-wave axis (54°); normal P-wave duration (80 ms); no increase in P-wave voltages; absence of P-wave morphology abnormalities (notched, biphasic, etc.); the remaining ECG also within normal limits;
Exergue
The normal P-wave is positive in leads I, II, V4 to V6, negative in aVR and often biphasic in V1 (occasionally V2); the duration of the P-wave does not exceed 110 ms (standard between 80 and 110 ms); the amplitude of the P-wave is less than 2.5 mm in limb leads, the positive deflection is less than 1.5 mm in V1 while the negative deflection is less 1 mm in V1.
This tracing shows an example of a strictly normal P-wave. Atrial activation is triggered in response to the depolarization of the sinus node and spreads radially and rapidly through the adjacent right atrial myocardium.