Tall peaked T waves are seen in leads V2-V4 (C2-C4). In addition there is prominent negative component for P wave in lead V1 (C1) suggestive of left atrial enlargement and tall R waves in V5, V6 (C5, C6) indicating left ventricular hypertrophy. Tall peaked T waves could occur both in hyperkalemia and hyperacute phase of acute myocardial infarction. Occasionally tall T waves are seen as normal variants as well. Tall T waves in lateral leads along with tall R waves may be noted in left ventricular volume overload. But in this ECG tall T waves are not seen in the leads with tall R waves. In hyperacute phase of myocardial infarction, the tall T waves have associated ST segment elevation or a rapidly upsloping ST segment.
In this ECG, in addition to tall peaked T waves (more peaked than in previous ECG), QRS complex is wide and has left bundle branch block pattern. There is ST segment depression and T wave inversion in the lateral leads, though the T waves are very tall and peaked in mid precordial leads. Left bundle branch block pattern is characterized by the wide notched QRS complexes in lead V6 with secondary repolarization abnormality in the form of ST segment depression and T wave inversion. the opposite pattern of a wide S wave with upsloping ST and upright T is seen in V1.