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The faster repolarization of the cardiac action potential causes the tenting of the T waves, and the inactivation of sodium channels causes a sluggish conduction of the electrical wave around the heart, which leads to smaller P waves and widening of the QRS complex.
Ischemia - Although a much less common cause of T wave peaking than hyperkalemia and normal repolarization variants â it should be appreciated that myocardial ischemia (in the area of the left ventricular posterior wall) may sometimes present with the ECG finding of tall, peaked T waves in the anterior leads.