P pulmonale
Also calledtall P wave · peaked P wave
Definition
P pulmonale is the tall, peaked P wave (amplitude greater than 2.5 mm, i.e. 0.25 mV, in lead II) that is the classic surface-ECG marker of right atrial enlargement (right atrial abnormality). It is an older name, later replaced by the term right atrial enlargement once it was realized that different clinical conditions cause similar P-wave changes. Total P-wave duration usually stays normal, because the right atrium is activated first: its larger activation adds to the early part of the P wave, summing with the left-atrial component, instead of extending the end of the P wave.
Source
- Hancock EW, Deal BJ, Mirvis DM, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy. Circulation. 2009;119(10):e251-e261. doi.org/10.1161/CIRCULATIONAHA.108.191097
Last reviewed 2 October 2026. Every definition in the EKG Dictionary cites the guideline, consensus statement or original paper it comes from.