Waves pr: Waves PR – Infectious enthusiasm

physiology, criteria & ECG findings – ECG & ECHO

The P-wave

ECG interpretation usually starts with assessment of the P-wave. The P-wave is a small, positive and smooth wave. It is small because the atria make a relatively small muscle mass. If the rhythm is sinus rhythm (i.e under normal circumstances) the P-wave vector is directed downwards and to the left in the frontal plane and this yields a positive P-wave in lead II (Figure 2, right hand side). The P-wave is always positive in lead II during sinus rhythm. This is rather easy to understand because lead II is angled alongside the P-wave vector, and the exploring electrode is located in front of the P-wave vector (Figure 2, right hand side).

This article is part of the comprehensive chapter: How to interpret the ECG

The P-wave vector is slightly curved in the horizontal plane. It is initially directed forward but then turns left to activate the left atrium (Figure 2, left hand side). Lead V1 might therefore display a biphasic (diphasic) P-wave, meaning that the greater portion of the P-wave is positive but the terminal portion is slightly negative (the vector generated by left atrial activation heads away from V1). Occasionally, the negative deflection is also seen in lead V2. lead V5 only notes vectors heading towards the exploring electrode (albeit with somewhat varying angles) and therefore displays a positive P-wave throughout.

Figure 2. P-wave morphology in chest and limb leads.

Figure 2 (above) does not show that the P-wave in lead II might actually be slightly asymmetric by having two humps. This is often (but not always) seen on ordinary ECG tracings and it is explained by the fact that the atria are depolarized sequentially, with the right atrium being depolarized before the left atrium. The first half of the P-wave is therefore a reflection of right atrial depolarization and the second half is a reflection of left atrial depolarization. This is shown in Figure 3 (upper panel). Recall that the P-wave in V1 is often biphasic, which is also shown in Figure 3.

Figure 3. The contour of the normal and abnormal P-wave (P pulmonale and P mitrale).

If an atria becomes enlarged (typically as a compensatory mechanism) its contribution to the P-wave will be enhanced. Enlargement of the left and right atria causes typical P-wave changes in lead II and lead V1 (Figure 3).

Enlargement of the right atrium is commonly a consequence of increased resistance to empty blood into the right ventricle. This may be due to pulmonary valve stenosis, increased pulmonary artery pressure etc. The right atrium must then enlarge (hypertrophy) in order to manage to pump blood into the right ventricle. Right atrial enlargement (hypertrophy) leads to stronger electrical currents and thus enhancement of the contribution of the right atrium to the P-wave. The P-wave will display higher amplitude in lead II and lead V1. Such a P-wave is called P pulmonale because pulmonary disease is the most common cause (Figure 3, P-pulmonale).

If the left atrium encounters increased resistance (e.g due to mitral valve stenosis) it becomes enlarged (hypertrophy) which amplifies its contribution to the P-wave. The second hump in lead II becomes larger and the negative deflection in V1 becomes deeper. This is called P mitrale, because mitral valve disease is a common cause (Figure 25, P-mitrale).

If the atria are depolarized by impulses generated by cells outside of the sinoatrial node (i.e by an ectopic focus), the morphology of the P-wave may differ from the P-waves in sinus rhythm. If the ectopic focus is located close to the sinoatrial node, the P-wave will have a morphology similar to the P-wave in sinus rhythm. However, an ectopic focus may be located anywhere. If it is located near the atrioventricular node, activation of the atria will proceed in the opposite direction, which produces an inverted (retrograde) P-wave.

P-wave checklist

• The P-wave is always positive in lead II during sinus rhythm.
• The P-wave is virtually always positive in leads aVL, aVF, –aVR, I, V4, V5 and V6. It is negative in lead aVR.
• The P-wave is frequently biphasic in V1 (occasionally in V2). The negative deflection is normally <1 mm.
• P-wave duration should be ≤0,12 seconds.
• P-wave amplitude should be <2,5 mm in the limb leads.
• P-pulmonale implies that the P-wave has abnormally high amplitude in lead II (and in other leads in general).
• P-mitrale implies that the second hump of the P-wave in lead II and the negative deflection of the P-wave in lead V1 are both enhanced.

PR interval and PR segment

The PR interval starts at the onset of the P-wave and ends at the onset of the QRS complex (Figure 1). It reflects the time interval from start of atrial depolarization to start of ventricular depolarization. The PR interval is assessed in order to determine whether impulse conduction from the atria to the ventricles is normal in terms of speed. The PR interval must not be too long nor too short. A normal PR interval ranges between 0.12 seconds to 0.22 seconds.

The flat line between the end of the P-wave and the onset of the QRS complex is called the PR segment and it reflects the slow impulse conduction through the atrioventricular node. The PR segment serves as the baseline (also referred to as reference line or isoelectric line) of the ECG curve. The amplitude of any deflection/wave is measured by using the PR segment as the baseline.

Figure 4. Impulse transmission from the atria to the ventricles. The PR interval reflects whether the impulse transmission through the AV-node is normal (first panel), abnormally slow (second panel) or bypassed (third panel).

Numerous conditions can diminish the capacity of the atrioventricular node to conduct the atrial impulse to the ventricles. As the conduction diminishes, the PR interval becomes longer. When the PR interval exceeds 0. 22 seconds, first-degree AV-block is manifest. The term block is somewhat misleading since it is actually a matter of abnormal delay and not a block per se. The most common cause of first-degree AV-block is degenerative (age-related) fibrosis in the conduction system. Myocardial ischemia/infarction and medications (e.g beta-blockers) may also cause first-degree AV-block. Note that the upper reference limit (0.22 seconds) should be related to the age of the patient; 0.20 seconds is more suitable for young adults because they have a faster impulse conduction. Refer to Figure 4 (second panel). AV-blocks are discussed in detail later.

The atrioventricular (AV) node is normally the only connection between the atria and the ventricles. The atria and the ventricles are electrically isolated from each other by the fibrous rings (anulus fibrosus). However, it is not rare to have an additional – accessory – pathway between the atria and the ventricles. Such an accessory pathway is an embryological remnant which may be located almost anywhere between the atria and the ventricles. It enables the atrial impulse to pass directly to the ventricles and start ventricular depolarization prematurely. If the atrial impulse uses an accessory pathway, the impulse delay in the atrioventricular node is bypassed and therefore the PR interval becomes shortened (PR interval <0.12 seconds). The condition is referred to as pre-excitation, because the ventricles are excited prematurely. This is illustrated in Figure 4 (third panel). As seen in Figure 4 (third panel) the initial depolarization of the ventricles (starting where the accessory pathway inserts into the ventricular myocardium) is slow because the impulse will not spread via the normal His-Purkinje pathway. The slow initial depolarization is seen as a delta wave on the ECG (Figure 4, third panel). However, apart from the delta wave, the R-wave will appear normal because ventricular depolarization will be executed normally as soon as the atrioventricular node delivers the impulse to the His-Purkinje system.

PR interval checklist

• Normal PR interval: 0,12–0,22 seconds. Upper reference limit is 0,20 seconds in young adults.
• A prolonged PR interval (>0.22 s) is consistent with first-degree AV-block.
• A shortened PR interval (<0,12 s) indicates pre-excitation (presence of an accessory pathway). This is associated with a delta wave.

This article is part of the comprehensive chapter: How to read and interpret the normal ECG

Nordic Waves

Pan-Scandinavian Music Promotion and Marketing

– brought to you by On It PR, Skiva Promotion and Tambourhinoceros

We offer promotion targeting radio, television, print and digital media as well as advertising across social media like YouTube, Facebook, Instagram, TikTok etc.

The 1975

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AUXÍLO

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The Blaze

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Brodie Sessions

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Efterklang

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Volna coworking for musicians in Krasnoyarsk

JOIN! STUDIO, PROJECTS, YOUTH ASSOCIATIONS IN THE MUSICAL CO-WORKING ROOM “VOLNA” (87, Krasnoyarsky Rabochy newspaper pr., T. 201-28-84)

Recording studio

Place and equipment for sound recording. Sound design, corporate sound. Sound recording of vocals, musical instruments, conferences. Restoration of audio materials. Mixing. Demo videos

Guitar club #on the wave

Head Andrey Arefiev
https://vk.com/nox_im_fine

Here you can learn how to play the guitar, sing, perform on a big stage, learn how to build chords and play scales, or how to make an electric guitar “squeal” and much more! For those who are especially serious, they provide a fully equipped rehearsal base and the opportunity to record their work in a recording studio. Club students participate in various events, competitions and festivals, and once a quarter they themselves arrange reporting concerts. To get into the club, you just need to come on the days of classes.

Classes are held in the music co-working “Volna” (pr-t. Krasnoyarsky worker, 87)

Schedule:

Monday, Wednesday, Friday 16:00 – 20:00

For all questions, you can contact the youth center group or the head of the studio.

Vocal studio

Schedule – individually after listening.
Recording for audition: 201-28-84.

Head: Marina Makhonina

Rehearsal base

Place and equipment for rehearsals. Tube 100W amps, drums, 500W bass cabinet and Line 6 portal system are waiting for you!

Co-working

Monday 12:00 – 22:00.
Tuesday 12:00 – 22:00.
Wednesday 12:00 – 22:00.
Thursday 12:00 – 22:00.

Friday 12:00 – 22:00.
Sunday 12:00 – 22:00.

An asset who regularly visits Volna coworking.

Age category 14-35 years.

Music coworking contacts “Volna”

Address — pr. im. newspaper “Krasnoyarsk worker”, 87
t. 201-28-84

Manager:

Alexander Sergeev

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Find directions to Volna, a co-working center for musicians

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What is music coworking “Volna”

The first coworking for musicians in Krasnoyarsk

A place for music lovers

Are you tired of your neighbors, they don’t let you enjoy music?
Do your guitar drinking disturb your parents?
Do you want to play drums?
Nowhere to meet and learn parts?
Chat with like-minded people?
– Then you are here!

To our cozy CO-WORKING FOR MUSICIANS.

What if I’m not a musician?

Lately, people have become more interested in our coworking space — they know about us, but not everyone knows what we are. Many are afraid of the prefix “musical” (perhaps they think that this is only for musicians). Therefore, for those who are interested and want to get to us NOT MUSICIANS – this is a short practical guide.

For starters, don’t be afraid of us. We do not expel anyone and do not meet on the threshold with the question: “What did you come for?”. Or rather, we meet, but we are only politely interested and to understand what a person needs and where to direct him.
A visit to our co-working space, and it consists of several large and small areas, is free – that is, no one will charge you for entry.

Free Wi-Fi. What else is needed? Xbox, of course!

What do we have? We have a sofa area, a kind of chill-out, where you can sit comfortably, surf the Internet with free Wi-Fi, watch a series-movie-concert with us (large screen and surround sound at your disposal).

Play “Halo” or “Mortal Kombat” on the X-box, read magazines, just chat. And you can arrange a tabletop tournament (although we only have Monopoly among the tabletops, but you can always bring the game with you).

We also have a turntable. If you have records, but you have nowhere or nothing to listen to them, then you can do it with us – alone or with friends – you choose. If you don’t have records, but still really want to listen, we have our own small collection from which you can choose the desired disc. Also, our administrator, who is an avid philophonist, regularly brings interesting vinyl from his collection. You can also learn from him how to properly use records and equipment or get advice on choosing equipment if you decide to start listening to records at home.

Guitar, drum and buns

Or play guitars or electronic drums. Guitars are acoustic, electric and bass. Combo cords are also available. And soft ottomans and bean bags. So you can play even standing, even sitting, even lying down. You can’t just play on your head, because it’s uncomfortable (but if you prove that you can play in this position without breaking your neck or instrument, then you are always welcome!).
We have a guitar club – anyone can come and learn to play the guitar. To do this, you only need a desire, even a guitar is not required, although if you have it, then it is better to take it with you.

If you are hungry or thirsty, we have a “tea table” with tea, coffee and sometimes buns. All this can be used absolutely freely, but if you throw a few coins into a special box – no matter how much it is a pity, then you will help us make sure that coffee and tea do not run out. By the way, you can bring buns with you: eat it yourself, treat friends or leave it as a contribution for coffee and tea.

Concerts, dance and vocal lessons

We also regularly host concerts and events. Entrance to them, as a rule, is free, we inform about all events in advance in the group, and in specially created meetings.

Also, twice a week, in the evenings, boys and girls gather to dance. You can join them and take part in this exciting and useful action.

And on Tuesdays we have a vocal day – you can come and sing in the concert hall to the phonogram (however, you will have to bring the phonogram and audio carrier with you, usually it is a tablet-phone-laptop). It is advisable to sign up in advance – there are many people who want to, and it is better to come at a certain time so as not to wait in line.
If you want to come another day, or you want to learn some song, work out individually with your teacher, then we have a room for individual lessons.
So, everything is very simple and not scary at all!

If you want to host your event at Volna, press the button and apply!

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