Difference between revisions of "T wave changes"

(Text replacement - "==Sources==" to "==References==")
(Evaluation)
 
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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
*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  
*Distribution
+
**Inversions in V2-V6 are usually pathologic
**T wave is normally inverted in aVR; sometimes inverted in III, aVF, aVL, V1  
+
***Exception is persistent juvenile T-wave pattern, usually limited to V1-V3, classically young Afro-Caribbean women
*T-wave inversions in V2-V6 are usually pathologic
+
*Greater than 2/3 height of R wave is abnormal
**With the exception of persistent juvenile T-wave pattern, usually limited to V1-V3, classically young Afro-Caribbean women
 
 
*Morphology  
 
*Morphology  
 
**Inverted, symmetric,  
 
**Inverted, symmetric,  

Latest 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).