T wave changes: Difference between revisions
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[[File:E0003192.png|thumb||Normal negative T waves in III, AVR and V1 (upright T wave in III is more common).]] | [[File:E0003192.png|thumb||Normal negative T waves in III, AVR and V1 (upright T wave in III is more common).]] | ||
*Normally upright in 1, 2, V3-V6 | *Normally upright in 1, 2, V3-V6 | ||
* | **Normally inverted in AVR and V1 | ||
* | **Sometimes inverted in III, aVF, aVL, V1 | ||
**New upright T wave in V1 or T wave taller in V1 than in V6 is pathologic | |||
* | **Inversions in V2-V6 are usually pathologic | ||
*T | ***Exception is persistent juvenile T-wave pattern, usually limited to V1-V3, classically young Afro-Caribbean women | ||
** | *Greater than 2/3 height of R wave is abnormal | ||
*Morphology | *Morphology | ||
**Inverted, symmetric, | **Inverted, symmetric, | ||
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**In presence of baseline TWI (within 1 month), reocclusion causes normalization of TWI | **In presence of baseline TWI (within 1 month), reocclusion causes normalization of TWI | ||
**Should be interpreted as evidence of ischemia | **Should be interpreted as evidence of ischemia | ||
*T wave alternans | |||
**Beat-to-beat variability in the amplitude OR shape of T waves | |||
**Highly suggestive of impending or recent [[torsades]] | |||
===New Tall T-wave in V1<ref>Wagner GS and Strauss DG. Marriott's Practical Electrocardiography. LWW; Twelfth edition (December 18, 2013).</ref>=== | ===New Tall T-wave in V1<ref>Wagner GS and Strauss DG. Marriott's Practical Electrocardiography. LWW; Twelfth edition (December 18, 2013).</ref>=== | ||
*Loss of precordial T-wave balance when upright TW in V1 > upright TW in V6 | *Loss of precordial T-wave balance when upright TW in V1 > upright TW in V6 | ||
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*[https://www.youtube.com/watch?v=adsnFeLGF8o Mattu ECG Case: Aug 27, 2012] | *[https://www.youtube.com/watch?v=adsnFeLGF8o Mattu ECG Case: Aug 27, 2012] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
Latest revision as of 16:06, 13 September 2023
Evaluation
- Normally upright in 1, 2, V3-V6
- Normally inverted in AVR and V1
- Sometimes inverted in III, aVF, aVL, V1
- New upright T wave in V1 or T wave taller in V1 than in V6 is pathologic
- Inversions in V2-V6 are usually pathologic
- Exception is persistent juvenile T-wave pattern, usually limited to V1-V3, classically young Afro-Caribbean women
- Greater than 2/3 height of R wave is abnormal
- Morphology
- Inverted, symmetric,
- Transient changes suggests ischemia without infarction
- Persistent changes suggests infarction (troponin elevation usually seen)
- Pseudonormalization
- In presence of baseline TWI (within 1 month), reocclusion causes normalization of TWI
- Should be interpreted as evidence of ischemia
- T wave alternans
- Beat-to-beat variability in the amplitude OR shape of T waves
- Highly suggestive of impending or recent torsades
New Tall T-wave in V1[1]
- Loss of precordial T-wave balance when upright TW in V1 > upright TW in V6
- A form of hyperacute T-wave
- New Tall T-Wave in V1 (NTTV1) = upright T-wave in V1, especially with proven change from previous ECG
- Concerning for ischemia, especially with ACS symptomology
- Perform repeat ECGs
- Normal variants
Differential Diagnosis
T Wave Inversions
- Normal in pediatrics
- Myocardial infarct (NSTEMI)
- Myocardial ischemia (Wellen's) - T waves go up, then down
- Hypokalemia - T waves go down, then up (or camel humped, one upright TW and upright U-wave in severe hypokalemia)
- Hyperkalemia
- Pulmonary embolism (RV strain)
- Pulmonary hypertension, acute or chronic
- Pulmonary disease - hyperventilation, pneumothorax, pneumonia
- LVH with strain pattern
- RVH
- Bundle branch block (both left and right)
- WPW
- Pericarditis (stage 3)
- CNS T waves (diffuse, deep)
- Arrhythmogenic right ventricular dysplasia (may also have epsilon wave)
- HOCM
- Paced rhythm
- Elevated intracranial pressure
Peaked T-waves
- MI (hyperacute T waves)
- Hyperkalemia
- Benign Early Repolarization
- De Winter's T waves (acute LAD occlusion)
See Also
References
- ↑ Wagner GS and Strauss DG. Marriott's Practical Electrocardiography. LWW; Twelfth edition (December 18, 2013).