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I saw my first biphasic p-wave.
“A ‘double hump’or notched P wave is diagnostic of LAE [left atrial enlargement] if the peaks are one small box or more apart. A biphasic P wave indicates left atrial enlargement if the downward portion of the P wave is one box or larger in both depth and length. Left atrial enlargement often occurs in mitral valve disease (either stenosis or insufficiency). Because of this association, a broad notched P wave is often called ‘P mitrale.’ In addition LAE often occurs with any cause of left ventricular hypertrophy.”