T wave changes

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Evaluation

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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).