P-pulmonale - ECG

P-pulmonale usually means the hypertrophy of the right atrium. It is a pointed P wave greater than 2.5 mm, which is best seen in leads perpendicular to the heart bottom wall (II, III, aVF) and chest leads V1 and V2.

 

P-pulmonale - ECGThe pointed P wave is most visible ECG in leads I, II, V1 and V2 (red)
 

Conclusion: From a clinical point of view it is good to know that P-pulmonale frequently occurs in patients with pulmonary hypertension and tricuspid valve defects.