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this occurs with a premature beat known as a PAC (premature atrial contraction) A t wave is ventricular repolarization (the ventricle getting ready to beat again. A premature atrial contraction may happen at this time but you can discern the actual p wave as it is hidden in the t wave. Pac's are normal, most people have them occasionally. They can increase with stress, caffeine, smoking. The other cause would be in an irregularly fast arrhythmia in with the heart is beating so fast that the p wave is coming very close to the t wave and hard to discern it

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