P Wave or T Wave?

Report:

Sinus bradycardia 37/min.

Left atrial abnormality .

First degree AV block.

Left bundle branch block

Comment:

The T wave is peaked and sharply demarcated from the preceding ST segment, mimicking a P' wave. Sequential strips (Fig 224a below) gradually dispel the illusion.

T wave is commonly notched in V2 or V3 in juvenile ECGs; here the angulation and the shape are probably due to progressive hyperkalæmia. The patien was no juvenile, either.

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