T wave changes

• Normally upright in 1, 2, V3-V6
• Negative in AVR
• If is greater than 2/3 height of R wave then is abnormal
• Deep symmetrical inverted T waves:

1. Left ventricle apical hypertrophy
2. Raised ICP (e.g. SAH)
3. Wellen's (MI)
4. Paced rhythm
5. BBB's or WPW
6. Idiopathic

• 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

See Also

• ECG Basics