P Axis on EKG

Hard to say..

by USMC-Pacer - 2024-08-19 14:34:44

Without knowing more about your condition. According to the link I'll paste below, it could be atrial enlargement. Have you had any of that usually noted on echocardiogram results? I have no idea what would cause that ?AFIB? and I'm sure other conditions. 

Take this with a grain of salt. Others will be along to chime in with more knowledge that I. 

Have you asked your cardiologist?

Here's the link I almost forgot :)

https://litfl.com/p-wave-ecg-library/

You are a challenge

by Gemita - 2024-08-20 04:46:59

Oh dear Amy, you have asked a difficult question for which there is no simple, short answer, but then we seem to thrive on these sort of posts, don’t we?  I am still learning this stuff too.  Not easy.

The QRS complex is often used to determine the axis of the electrocardiogram, although it is also possible to determine a separate P wave axis.   P-wave axis is a measure of the net direction of atrial depolarization.  The normal P-wave axis is defined by angles between 0 and 75 degrees. 

An abnormal P-wave axis is thought to be a marker of left atrial fibrosis and delayed conduction, leading to atrial arrhythmias like atrial fibrillation, but I won’t try to give an opinion on your recent slightly higher than normal values.  They may or may not be of any significance and only your doctors can possibly confirm this. 

The QRS axis as you will see from the link attached if you wish to read further, is an important measurement on the 12-lead ECG, although it is subject to various pitfalls and inaccuracies. These include a wide natural variation in normal values, changes that occur in response to ageing and body shape, and susceptibility to wild inaccuracy if limb leads are transposed!

Accurate assessment of the QRS axis is a vital part of systematic 12-lead ECG interpretation. Although axis deviation may be a benign and a normal finding, in many cases it reflects changes in the structure or electrical activation of the heart chambers. 

The QRS axis provides important diagnostic information about the flow of electricity through the ventricles, and is useful in diagnosing abnormalities in both the structure and electrical function of the heart.  Axis can be key to diagnosing a variety of arrhythmias. Ventricular tachycardia will normally show an extreme right (north-west) QRS axis, due to the ectopic focus located in the ventricle for example.

Axis is often considered a difficult subject in ECG interpretation.  This difficulty may be compounded by a plethora of methods suggested for axis evaluation, and by a lack of conformity in the literature about where the normal axis lies, and what causes it to be abnormal.

QRS axis represents the net direction of depolarisation within the ventricles, and is measured using the limb leads. A normal axis lies between -30 and +90 degrees; anything outside of this range is referred to as axis deviation.

Axis deviation may be a normal variant, but is often the result of structural or electrical heart disease.  Axis is calculated by most ECG machines and is usually accurate, but doctors should be able to verify axis manually, in case of machine error.

Hope nothing untoward is found.

https://core.ac.uk/download/pdf/227105157.pdf

Reached out to my EP

by Amyelynn - 2024-08-20 13:23:11

I messaged my EP through mychart because that's the easiest way to get through to doctors ( at least here in CA) 

A nurse responded:

The interpretation you are seeing an eletronic reading. The doctor personally reviews your EKG and takes into account your clinical presentation.

If there was anything of concern regarding your EKG she would have discussed that at the time of your visit.

She does not note any concerns.

Cindy Pacheco, RN

should I be satisfied with that response?

I feel like I want to reply something along the lines of. That's great that there is no concern but given the drastic change in P Axis could I at least get an explanation on the change im seeing as I like to be as knowledgeable as possible when it comes to my health. 
 

is that reasonable?
 

id like to also mention in my message to the doctor I mentioned how I have been getting feelings of pounding heart rate/fluttering feelings while sitting/laying at rest (but thought it was all in my head) wasn't sure if could be any connection. 
that was clearly ignored and no response concerning that. 

Not good enough!

by Gemita - 2024-08-20 13:40:46

Amy, absolutely not.  I would have been most disappointed with that response, but I am afraid it is all too familiar.  Mostly I am lucky enough when emailing my clinic to get a helpful, detailed response, but on rare occasions, I feel I am becoming a nuisance to want to know more! 

I think it is perfectly reasonable for you to follow up with the additional question, but I wonder if the nurse is prepared to give you a satisfactory answer to what we know is a technical question?  

Your rhythm disturbances - pounding heart rate/flutter feelings at rest are not all in your head and it is perfectly normal to want to mention this.  If you made a note of the time and day/night you noticed these symptoms, that would be even better for them to look at your pacemaker transmissions.  If you don’t get a decent response, keep evidence of your symptomatic periods, or capture these on Kardia Mobile/smart watch and take the evidence with you to your next appointment

Good news

by Amyelynn - 2024-08-21 21:21:45

Doctor says:

"If your heart gets paced in the atrium you atrial activity initiates in a different location than your normal sinus rhythm so the axis will change. The variation in axis as long as the rhythm is stable is not concerning."

I think drastic change because my atrial is now pacing about 86% used to only be pacing 30% but over past year has increased significantly. Ventricle has always paced 100.

Thank you Amy

by Gemita - 2024-08-21 23:56:52

Amy, thank you so much for that update.  So helpful.  I think I understand what your doctor is saying and this makes a lot of sense . . 

"If your heart gets paced in the atrium, your atrial activity initiates in a different location than your normal sinus rhythm (SA Node) so the axis will change. The variation in axis as long as the rhythm is stable is not concerning.” 

I understand this to mean that our Right Atrial lead tip will not be positioned in the exact same location as our SA node and therefore the axis will of course change and that this causes the variation in axis?  That is an easy simple answer if my understanding is correct.

However your doctor’s additional comment: “The variation in axis, as long as the rhythm is stable, is not concerning” hasn’t been addressed.  Did you ever get an answer about your “pounding heart rate/fluttering while sitting/at rest and whether there could be any connection with the variation in axis?

Whether or not you wish to follow up any further is your decision.  Clearly your doctor isn't at all concerned at this point, so that is indeed good news as you say, but do watch for any unusual rhythm disturbances and report these promptly in the future Amy just to be safe.

Thank you again for that simple definition.  How much we are all learning