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Patient
37-year-old man with hypertrophic cardiomyopathy;
Trace
Sinus rhythm with fixed and prolonged PR-interval (220 ms, first degree atrioventricular block); tall and symmetrical T-waves in V2-V6; T-wave amplitude in V3 (> 15 mm) is greater than the size of the preceding S wave or R wave;
Patient
79-year-old man receiving inttermittend hemodialysis for chronic renal failure, hospitalized for syncope;
Trace
High grade atrioventricular block with several consecutive blocked P-waves followed by 1 to 2 conducted P-waves; moderate prolongation of QRS with right bundle branch block pattern; tall and symmetrical T-waves from V2 to V5; relatively short QT-interval in keeping with bradycardia; this ECG is evocative of a hyperkalemia which was confirmed by blood analysis;
Exergue
The presence of tall T-waves in a setting of recent onset chest pain should evoke the diagnosis of myocardial infarction with ST elevation at a very early stage.
There are several values in the literature defining a tall T-wave although the size of the T-wave is generally indexed to that of the R wave preceding it; the amplitude of the T-wave must not exceed 75% of the R wave or S wave.