T wave changes: Difference between revisions

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==Diagnosis==
==Evaluation==
[[File:SinusRhythmLabels.svg|thumb]]
[[File:T wave morphology.png|thumb|Types of T wave morphology]]
[[File:T wave morphology.png|thumb|Types of T wave morphology]]
[[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
*Negative in AVR
**Normally inverted in AVR
*If is greater than 2/3 height of R wave then is abnormal
**Sometimes inverted in III, aVF, aVL, V1  
 
**Inversions in V2-V6 are usually pathologic
*Distribution
***Exception is persistent juvenile T-wave pattern, usually limited to V1-V3, classically young Afro-Caribbean women
**T wave is normally inverted in aVR; sometimes inverted in III, aVF, aVL, V1  
*Greater than 2/3 height of R wave is abnormal
*T-wave inversions in V2-V6 are always pathologic  
*Morphology  
*Morphology  
**Inverted, symmetric,  
**Inverted, symmetric,  
**Transient changes suggests ischemia without infarction  
**Transient changes suggests ischemia without infarction  
**Persistent changes suggests infarction (troponin elevation usually seen)  
**Persistent changes suggests infarction ([[troponin]] elevation usually seen)  
*Pseudonormalization  
*Pseudonormalization  
**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
===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
*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
**Misplaced leads
**[[LBBB]]
**[[LVH]]
**High left ventricular voltage


==Differential Diagnosis==
==Differential Diagnosis==
===T Wave Inversions===
{{T-wave inversion DDX}}
*[[Myocardial infarct]] (NSTEMI)
 
*Myocardial ischemia ([[Wellen's]])
{{Peaked T-waves DDX}}
*[[Pulmonary embolism]] (RV strain)
*[[LVH]] with strain pattern
*[[Bundle branch block]]
*[[WPW]]
*[[Pericarditis]] (stage 3)
*CNS T waves (diffuse, deep)
*[[ARVD]] (may also have epsilon wave)
*Paced rhythm


==See Also==
==See Also==
*[[ECG Basics]]
*[[ECG Basics]]
*[https://www.youtube.com/watch?v=adsnFeLGF8o Mattu ECG Case: Aug 27, 2012]
==References==
<references/>


[[Category:Cards]]
[[Category:Cardiology]]

Revision as of 00:36, 28 February 2019

Evaluation

SinusRhythmLabels.svg
Types of T wave morphology
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 inverted in AVR
    • Sometimes inverted in III, aVF, aVL, V1
    • 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

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
    • Misplaced leads
    • LBBB
    • LVH
    • High left ventricular voltage

Differential Diagnosis

T Wave Inversions

Peaked T-waves

See Also

References

  1. Wagner GS and Strauss DG. Marriott's Practical Electrocardiography. LWW; Twelfth edition (December 18, 2013).