Question:
Pseudo P pulmonale on the ECG is associated with which electrolyte abnormality?
Pseudo P pulmonale on the ECG is associated with which electrolyte abnormality?
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A tall peaked P without real RA enlargement, plus U waves and ST depression, points to low potassium.
Updated On: Jun 23, 2026
- Hypokalemia
- Hyponatremia
- Hypocalcemia
- Hypercalcemia
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The Correct Option is A
Solution and Explanation
Step 1: True "P pulmonale" is a tall, peaked P wave (usually >2.5 mm in lead II) that reflects right atrial enlargement, classically from pulmonary hypertension or tricuspid stenosis.
Step 2: "Pseudo P pulmonale" is an identical-looking tall, peaked P wave but WITHOUT actual right atrial enlargement. It is produced metabolically rather than structurally.
Step 3: The classic cause of this pseudo pattern is HYPOKALAEMIA, which alters atrial repolarisation and accentuates the P wave (it also causes ST depression, flat T waves, prominent U waves). Hence option a is correct.
Step 4: The other electrolyte changes do not produce this picture: hypocalcaemia prolongs the QT interval, hypercalcaemia shortens QT, and hyponatraemia has no characteristic peaked-P effect. So hypokalaemia is the answer.
Step 2: "Pseudo P pulmonale" is an identical-looking tall, peaked P wave but WITHOUT actual right atrial enlargement. It is produced metabolically rather than structurally.
Step 3: The classic cause of this pseudo pattern is HYPOKALAEMIA, which alters atrial repolarisation and accentuates the P wave (it also causes ST depression, flat T waves, prominent U waves). Hence option a is correct.
Step 4: The other electrolyte changes do not produce this picture: hypocalcaemia prolongs the QT interval, hypercalcaemia shortens QT, and hyponatraemia has no characteristic peaked-P effect. So hypokalaemia is the answer.
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