A tall P wave is more than 2.5 mm tall (or >1.5 mm in the chest leads V1-V6) at standard settings. This can be associated with right atrial enlargement, but it is not diagnostic. Tall peaked P waves are also known as P pulmonale because of the association between pulmonary hypertension and right atrial enlargement. Exceptionally tall P waves are also known as Himalayan P waves and are classically associated with Ebstein’s anomaly.See also: P wave
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