T wave changes: Difference between revisions
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[[File:T wave morphology.png|thumb|Types of T wave morphology]] | [[File:T wave morphology.png|thumb|Types of T wave morphology]] |
Revision as of 16:49, 25 July 2016
Evaluation
- Normally upright in 1, 2, V3-V6
- Negative in AVR
- If is greater than 2/3 height of R wave then is abnormal
- Distribution
- T wave is normally inverted in aVR; sometimes inverted in III, aVF, aVL, V1
- T-wave inversions in V2-V6 are always pathologic
- 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
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)