Pseudo P pulmonale pattern associated with severe hypokalemia

This study presents the case of a 54-year-old man who presented with weakness in his lower extremities and tall P waves on electrocardiography (ECG). At admission, ECG revealed tall P waves (0.32 mV, lead II) at a serum potassium level of 1.21 mmol/L. After potassium supplementation, the amplitude of P waves decreased and returned to normal. A tall P wave may not be a real P pulmonale pattern but a pseudo P pulmonale pattern associated with hypokalemia. •The tall P wave, not always suggests real P pulmonale pattern, but a pseudo P pulmonale pattern associated with hypokalemia.•When the P pulmonale pattern is accompanied by typical ECG findings of hypokalemia, it might be pseudo due to hypokalemia.•Perhaps the cause of increase in P wave is partly due to the overlap of P wave and U wave.