This 67-year-old man who suffered from a myocardial infarction 3 year ago has been admitted for treatment of congestive heart failure:

• Probably sinus tachycardia with first degree AV block (PR = 400 msec.)
• Anterior infarction

Comment: The P wave that follows closely the QRS complex is positive in II, III and aVF and isoelectric in I. It is therefore not a “retrograde P”. It originates either from the sinus node or from the upper atrial region.

The patient is readmitted 2 months later because of recurrence of heart failure:

• Sinus rhythm with Mobitz I second degree AV block
• Anterior infarction
• T wave abnormality, consider inferior-lateral ischemia