II. Findings: Normal

  1. Upright: I, II, V3, V4, V5, V6
  2. Inverted: aVR, V1
  3. Variable: all other leads
  4. Increased Amplitude: aVL and aVF (if QRS over 5 mm)
  5. Shape: Asymmetrical
    1. An upright T Wave normally rises gradually, and falls with a steeper slope

III. Findings: T Wave Shape

  1. Smooth: Normal
  2. Notched: Pericarditis
  3. Pointed: Myocardial Infarction
  4. T Wave Alternans
    1. Upright T Wave alternates with inverted T Wave on every other beat
    2. Ominous finding that heralds Cardiac Arrest

IV. Findings: T Wave Height

  1. Normal
    1. Limb leads: <5 mm
    2. Precordial leads: < 10 mm
  2. Tall T Wave Causes
    1. Hyperkalemia
    2. Myocardial Infarction
    3. Myocardial Ischemia
    4. Cerebrovascular Accident

V. Causes: T Wave Inversion in anterior leads (V1 to V4)

  1. Anterior Myocardial Ischemia
  2. Proximal Left Anterior Descending Occlusion
    1. See Wellen's Syndrome
    2. Deeply inverted T Waves or biphasic T Waves in V2-3
  3. Posterior Myocardial Infarction
  4. Pulmonary Embolism with right heart strain
  5. Neurogenic T Waves
    1. Precedes ischemic cerebrovascular event
  6. Yamaguchi Syndrome
    1. Hypertrophic Cardiomyopathy involving the cardiac apex
  7. References
    1. Majoewsky (2012) EM:RAP 12(1): 12

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Related Studies

Ontology: T wave feature (C0429103)

Concepts Finding (T033)
SnomedCT 142097004, 41011002
English T wave feature, t waves, t wave, T wave (observable entity), T wave, T wave feature (observable entity)
Spanish onda T (entidad observable), onda T