This case report is kindly provided by Michael Rosengarten from McGill and is part of the McGill Cases. These cases come from the McGill EKG World Encyclopedia.


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The recording shows sinus rhythm and a broad P wave in the inferior leads. The P wave is notched and the separation between the peaks is more than 40 ms. and the total p duration is more than 120 ms. This is suggestive of left atrial abnormality. The poor r wave progression in the precordial leads suggests a previous anterior wall myocardial infarction.