Cerebral T waves due to intracerebral hemorrhage or ischemic stroke mandate appropriate management as outlined in the respective chapters. Likewise, the management of pulmonary embolism and pericarditis are reviewed in respective chapters. The most common pitfall associated with interpretation of abnormalities of the T waves is not integrating the ECG findings with findings of history, physical examination, and selected laboratory and imaging studies to identify emergent conditions.
For example, a high-risk acute coronary syndrome can be present in the face of a normal ECG, and a flagrantly abnormal ECG with T wave inversions can be present without ischemia, attributable to multiple other diagnoses as above.
Morris, F, Brady, WJ.. Part I. Channer, K, Morris, S. Slovis, C, Jenkins, R.. Ann Em Med. All rights reserved. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC.
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Jump to Section I. Diagnostic Approach. What is the differential diagnosis for this problem? Tall T waves Inverted T waves B.
Historical information important in the diagnosis of this problem. Physical Examination maneuvers that are likely to be useful in diagnosing the cause of this problem. Laboratory, radiographic and other tests that are likely to be useful in diagnosing the cause of this problem. Management while the Diagnostic Process is Proceeding. What's the evidence? Please login or register first to view this content.
Open Next post in Hospital Medicine Close. Want to view more content from Cancer Therapy Advisor? The causes of T-wave inversions have commonly been grouped into 2 categories: primary T-wave changes and secondary T-wave changes.
Secondary T-wave changes result from aberrant ventricular activation in the context of normal action potential characteristics; examples include bundle-branch blocks, ventricular pre-excitation states eg, Wolff-Parkinson-White syndrome , ventricular paced rhythms, and ventricular ectopic beats.
In general, inverted T waves related to acute coronary syndrome are symmetric in shape; this symmetry means that the downsloping limb is a mirror image of the upsloping limb. An important subgroup of patients with pre-infarction.
Figure 2A. Pulmonary embolism angina ie, unstable angina can present with significantly abnormal T-wave inversions-either symmetric, deeply inverted T waves or biphasic T waves in the precordial leads V1, V2, and V3 in particular. In patients with this history and these ECG findings, Wellen syndrome is diagnosed, which is frequently associated with proximal left anterior descending coronary artery critical stenosis; the natural history of Wellen syndrome is anterior wall ST-segment elevation myocardial infarction.
Lastly, patients with past MI can demonstrate persistent T-wave inversions as a manifestation of the MI. The T-wave findings in these patients are typically shallow inversions in the inferior leads. Deeper T-wave inversions-attributed to acute right ventricular strain and occasionally seen in patients with massive PE-are generally.
Figure 2B. CNS vascular event subarachnoid hemorrhage observed in the right to mid-precordial leads V1 to V4; this finding is the most specific ECG finding seen in the PE patient. Acute myocarditis and acute myopericarditis can present with a range of ECG abnormalities, including ST-segment elevation and T-wave inversion.
T-wave inversion is not seen in all such cases of myocardial inflammatory disorders. When it is seen in these patients, T-wave inversion usually indicates a resolving process. There are a number of neurogenic causes of primary T-wave inversions. For example, the T waves in patients who have sustained a CNS. Figure 2C. Volume Article Contents References. T wave inversion on the electrocardiogram: when to worry and when not to. Filippo Stazi Filippo Stazi. Oxford Academic. Select Format Select format.
Permissions Icon Permissions. T wave inversion , Right ventricular arrhythmogenic cardiomyopathy , Hypertrophic cardiomyopathy. Google Scholar Crossref. Search ADS.
Published on behalf of the European Society of Cardiology. For commercial re-use, please contact journals. Issue Section:. There are two causes for camel hump T waves:. Dynamic T-wave flattening due to anterior ischaemia above. T waves return to normal once the ischaemia resolves below. Note global T-wave flattening in hypokalaemia associated with prominent U waves in the anterior leads V2 and V3.
Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. This site uses Akismet to reduce spam.
Learn how your comment data is processed. ECG Library Homepage. Tall, narrow, symmetrically peaked T-waves are characteristically seen in hyperkalaemia. Prinzmetal angina. Inverted T-waves in the right precordial leads V are a normal finding in children, representing the dominance of right ventricular forces.
Inferior T wave inversion due to acute ischaemia. Inferior T wave inversion with Q waves — prior myocardial infarction. T wave inversion in the lateral leads due to acute ischaemia. Anterior T wave inversion with Q waves due to recent MI.
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