Tall T waves seen in leads V3 and V4 are normal variants sometimes. Tall tented T waves can also be a feature of hyperkalemia. Tall T waves along with tall R waves in lateral leads are seen in left ventricular volume overload situations like severe aortic regurgitation. Tall T waves may also be noted in hyperacute phase of myocardial infarction. Hence interpretation without knowing the clinical background may be erroneous in some instances. Whenever there is a doubt, serial ECGs and serum potassium estimation will help in sorting out the cause of tall T waves. Left ventricular volume overload situations can be confirmed by echocardiography.