T wave changes: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
[[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).]] | [[File:E0003192.png|thumb||Normal negative T waves in III, AVR and V1 (upright T wave in III is more common).]] | ||
Revision as of 04:17, 6 June 2015
Diagnosis
- 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
- Myocardial infarct (NSTEMI)
- Myocardial ischemia (Wellen's)
- 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