76-year-old female with hypertension, diabetes, and end stage renal disease on hemodialysis was sent to the emergency department for complaining of neck and jaw pain associated with hypotension during dialysis. Her electrocardiogram is shown in figure 1. Clearly, biphasic T waves can be seen in V2-V3. These T wave changes were not seen in her last EKG. (figure 2). She was asymptomatic in the emergency department and her troponins were negative. Her electrolytes were also within normal limits with normal vital signs. Her cardiovascular exam was unremarkable.