6. T Wave Overview - ECG assessment and ECG interpretation made easy

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6. T Wave Overview - ECG assessment and ECG interpretation made easy

The T wave is the positive deflection after each QRS complex. It represents ventricular repolarisation.

Normal T wave characteristics
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Upright in all leads except aVR and V1
Amplitude Less than 5mm in limb leads, Less than 10mm in precordial leads (10mm males, 8mm females)
Duration relates to QT interval

Loss of precordial T-wave balance
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Loss of precordial T-wave balance occurs when the upright T wave is larger than that in V6. This is a type of hyperacute T wave.

The normal T wave in V1 is inverted. An upright T wave in V1 is considered abnormal — especially if it is tall (TTV1), and especially if it is new (NTTV1).
This finding indicates a high likelihood of coronary artery disease, and when new implies acute ischemia

Inverted T waves
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Inverted T waves are seen in the following conditions:

Normal finding in children
Persistent juvenile T wave pattern
Myocardial ischaemia and infarction (including Wellens Syndrome)
Bundle branch block
Ventricular hypertrophy (‘strain’ patterns)
Pulmonary embolism
Hypertrophic cardiomyopathy
Raised intracranial pressure

** T wave inversion in lead III is a normal variant. New T-wave inversion (compared with prior ECGs) is always abnormal. Pathological T wave inversion is usually symmetrical and deep (Greater than 3mm).

Hyperacute T waves (HATW)
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Broad, asymmetrically peaked or ‘hyperacute’ T-waves (HATW) are seen in the early stages of ST-elevation MI (STEMI), and often precede the appearance of ST elevation and Q waves. Particular attention should be paid to their size in relation to the preceding QRS complex, as HATW may appear ‘normal’ in size if the preceding QRS complex is of a small amplitude.

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