T wave changes: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
===T Wave Inversions=== | {{T-wave inversion DDX}} | ||
===[[T wave changes|T Wave Inversions]]=== | |||
*[[Myocardial infarct]] (NSTEMI) | *[[Myocardial infarct]] (NSTEMI) | ||
*Myocardial ischemia ([[Wellen's]]) | *Myocardial ischemia ([[Wellen's]]) | ||
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*Paced rhythm | *Paced rhythm | ||
{{Peaked T-waves DDX}} | |||
==See Also== | ==See Also== | ||
Revision as of 08:41, 8 March 2016
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
- 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
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)
- Arrhythmogenic right ventricular dysplasia (may also have epsilon wave)
- Paced rhythm
Peaked T-waves
- MI (hyperacute T waves)
- Hyperkalemia
- Benign Early Repolarization
- De Winter's T waves (acute LAD occlusion)