ECG Guru - Instructor Resources - Giant T waves https://www.ecgguru.com/ecg/giant-t-waves en Giant T Wave Inversions https://www.ecgguru.com/ecg/giant-t-wave-inversions-0 <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/giant-t-wave-inversions-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/060403%20Giant%20T%20wave%20inversions%20Edit%20for%20Guru_1.jpg" width="1648" height="929" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal">This ECG was obtained from a man in his 70’s.&nbsp; We have no other clinical information.&nbsp; It is interesting for several reasons.<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal"><strong>Giant T wave inversions</strong> &nbsp; &nbsp;&nbsp;<span style="font-size: 13.008px; line-height: 1.538em;">The most obvious abnormalities we see on first inspection are the deeply inverted T waves in Leads V3 through V6. The T wave in V3 is biphasic.&nbsp;There are also T wave inversions in all of the limb leads except aVR.&nbsp; The precordial T wave inversions are called “giant T wave inversions” because they are 10 mm or more in depth.&nbsp; There are many causes of giant T wave inversions, including, but not limited to: myocardial ischemia, coronary artery disease and reperfusion, pulmonary edema, massive pulmonary embolism, subarachnoid hemorrhage, apical hypertrophy, post-tachycardia syndrome, and post-pacing syndrome.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal"><strong>What else?</strong> &nbsp; &nbsp; There are no Q waves or ST elevations.&nbsp; The ST segments are not entirely normal in shape, being flattened in most lead.&nbsp; The frontal plane axis is left.&nbsp; Even though the ECG <em>almost </em>meets <a title="LVH criteria" href="http://ecg.utah.edu/lesson/8"><span style="color: #2e75b6; mso-themecolor: accent1; mso-themeshade: 191; mso-style-textfill-fill-color: #2E75B6; mso-style-textfill-fill-themecolor: accent1; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">criteria for left ventricular hypertrophy</span></a>, by exclusion we would call this anterior fascicular block (left anterior hemiblock).&nbsp; &nbsp;Obviously, it would help greatly if we had some history and clinical information to accompany this ECG.<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">If the patient has complained of chest pain which has now resolved, we would be concerned about reperfusion T waves, or <span style="color: #0070c0;"><a title="Wellens Syndrome litfl" href="http://lifeinthefastlane.com/ecg-library/wellens-syndrome/">Wellen’s Syndrome</a>.&nbsp; </span>Usually, the T wave changes of Wellen’s Syndrome are prominent in V2 and V3, but we would consider the possibility of a not-so-correct electrode placement.&nbsp;<span style="font-size: 13.008px; line-height: 1.538em;">The reperfusion T wave inversions of Wellen’s Syndrome are a dire warning:</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; </span><span style="font-size: 13.008px; line-height: 1.538em;">the left coronary artery has significant disease, and is intermittently occluding.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp; Wellen's Syndrome means that a</span><span style="font-size: 13.008px; line-height: 1.538em;">cute anterior wall M.I. is threatening.</span></p><p class="MsoNormal"><strong>The rhythm is also interesting</strong>.&nbsp; From beat 4 until beat 10, the rhythm is fairly regular, but with slight variations in rate.&nbsp; Beats 7 and 11 may have slightly different P waves, but only to those who scrutinize very closely.&nbsp; Beats 1, 2, and 3 are irregular and have inverted P waves in the inferior leads, a sign that they are being conducted in a retrograde direction.&nbsp; The PR intervals seem to be shortening in beats 2 and 3, but there is not enough strip at that end to know for sure what is happening.&nbsp; Then, at the end of the strip, beat 12 arrives so early that we can’t evaluate the P wave, as it is buried in the T wave of beat 11.<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal"><strong>For comparison &nbsp; &nbsp;&nbsp;</strong>There is <a title="Deep symmetrical T wave inversions" href="http://ecgguru.com/ecg/deep-symmetrical-t-wave-inversions"><span style="color: #2e75b6; mso-themecolor: accent1; mso-themeshade: 191; mso-style-textfill-fill-color: #2E75B6; mso-style-textfill-fill-themecolor: accent1; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">another ECG </span></a>with giant T wave inversion on our site that you might like to look at for comparison purposes. &nbsp;Dr. Ken Grauer also has a nice <a title="Dr. Grauer T wave inversions" href="http://ecg-interpretation.blogspot.com/2013/01/ecg-interpretation-review-59-t-wave.html?m=1"><span style="color: #2e75b6; mso-themecolor: accent1; mso-themeshade: 191; mso-style-textfill-fill-color: #2E75B6; mso-style-textfill-fill-themecolor: accent1; mso-style-textfill-fill-alpha: 100.0%; mso-style-textfill-fill-colortransforms: lumm=75000;">example</span></a>, with thorough discussion, on his website. I will look forward to any comments from our experts and our readers.</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/632/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Giant T Wave Inversions 1/5</option><option value="40">Give Giant T Wave Inversions 2/5</option><option value="60">Give Giant T Wave Inversions 3/5</option><option value="80">Give Giant T Wave Inversions 4/5</option><option value="100" selected="selected">Give Giant T Wave Inversions 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >4.2</span></span> <span class="total-votes">(<span >5</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-yEx2YAjpy4tBR7ipLamMWkaes0vZcqqL9oKmzuB7crg" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/giant-t-waves" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Giant T waves</a></div><div class="field-item odd"><a href="/ecg/t-wave-inversion" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">T Wave Inversion</a></div><div class="field-item even"><a href="/ecg/ischemia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ischemia</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fgiant-t-wave-inversions-0&amp;title=%20Giant%20T%20Wave%20Inversions%20"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Tue, 24 May 2016 21:17:47 +0000 Dawn 699 at https://www.ecgguru.com https://www.ecgguru.com/ecg/giant-t-wave-inversions-0#comments Deep, Symmetrical T Wave Inversions https://www.ecgguru.com/ecg/deep-symmetrical-t-wave-inversions <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/deep-symmetrical-t-wave-inversions"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/T%20wave%20inversions.jpg" width="1800" height="614" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal">This ECG is from a 50-year-old man with chest pain.&nbsp; Unfortunately, we don’t have any other clinical information.&nbsp;&nbsp; This tracing is a good example of widespread, symmetrical inverted T waves.&nbsp; Inverted T waves are present in Leads I, aVL, II, and V3 through V6. (The anterior-lateral leads).&nbsp; There are ST segment elevations in Leads V1 and V2.&nbsp;<span style="font-size: 8pt; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">Many conditions can cause inverted T waves, and bedside assessment is necessary to make a certain diagnosis.&nbsp; Some T wave inversions are benign, such as in persistent juvenile T wave pattern.&nbsp; Some can be due to life-threatening problems like pulmonary embolism, CNS injury, and cardiac ischemia.&nbsp; T wave inversions can be secondary to conditions like left ventricular hypertrophy, left bundle branch block, and ventricular rhythms.&nbsp; When T waves are deep and symmetrical as they are here, they may be a sign of acute coronary syndrome, or cardiac ischemia.&nbsp; Since we know this patient had chest pain, and there is some ST elevation, this should be considered as a cause for his T wave changes.<span style="font-size: 8pt; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">In addition to the dramatic T waves, he also has P waves suggestive of “P mitrale”, or left atrial enlargement.&nbsp; The P waves in Lead II are wide (about 10 or 11 ms) and just over 1 mv tall. This is “borderline” for most <a href="http://lifeinthefastlane.com/ecg-library/basics/left-atrial-enlargement/">LAE criteria</a>. &nbsp;&nbsp;The P waves in Lead V1 are biphasic, with the second portion negatively deflected and over 1 mv deep.&nbsp; Acute myocardial infarction can cause left ventricular dysfunction, which can cause backup pressure to the left atrium.<span style="font-size: 8pt; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal">Inverted T waves, like all ST and T wave changes, should always be assessed in the context of the patient presentation, history, and previous ECGs, if available.<span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p><span style="font-size: 11.0pt; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">References:&nbsp; <a href="http://www.consultantlive.com/cardiovascular-diseases/inverted-t-wave-differential-diagnosis-adult-patient">Consultantlive.com, </a>&nbsp;&nbsp;<a href="http://ecg-interpretation.blogspot.com/2013/01/ecg-interpretation-review-59-t-wave.html">Dr. Ken Grauer</a> </span></p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/632/feed" method="post" id="fivestar-custom-widget--2" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--4" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Deep, Symmetrical T Wave Inversions 1/5</option><option value="40">Give Deep, Symmetrical T Wave Inversions 2/5</option><option value="60">Give Deep, Symmetrical T Wave Inversions 3/5</option><option value="80" selected="selected">Give Deep, Symmetrical T Wave Inversions 4/5</option><option value="100">Give Deep, Symmetrical T Wave Inversions 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.4</span></span> <span class="total-votes">(<span >5</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--2" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-KYviPNwjwnsHcq4h3Zcd9HruSZRyNaMtqPgGmP9dHTk" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/t-wave-inversion" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">T Wave Inversion</a></div><div class="field-item odd"><a href="/ecg/ischemia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Ischemia</a></div><div class="field-item even"><a href="/ecg/coronary-syndrome" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Coronary syndrome</a></div><div class="field-item odd"><a href="/ecg/giant-t-waves" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Giant T waves</a></div><div class="field-item even"><a href="/ecg/left-ventricular-hypertrophy" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Left ventricular hypertrophy</a></div><div class="field-item odd"><a href="/ecg/coronary-artery-disease-0" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Coronary artery disease</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_2"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fdeep-symmetrical-t-wave-inversions&amp;title=Deep%2C%20Symmetrical%20T%20Wave%20Inversions"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Wed, 16 Dec 2015 03:20:58 +0000 Dawn 680 at https://www.ecgguru.com https://www.ecgguru.com/ecg/deep-symmetrical-t-wave-inversions#comments