CMC ECG MASTERS
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Inverted T Waves

ISCHEMIA
  • Localized
  • Deep, symmetrical (V-shaped)
  • Biphasic (positive-negative)
  • ST segments frequently at baseline (isolated T wave inversion without ST depression)
Picture
Deep, symmetric T waves
Picture
Biphasic T waves

STRAIN
  • Strain pattern: upsloping ST depression followed by non-symmetrical T wave inversion (shallow downslope, rapid upslope)

LV strain: seen in left leads (I, aVL, V5-V6) – usually in association with LVH
Picture
LV Strain
RV strain: seen in anterior precordial leads (V1-V3) – differential diagnosis includes anterior ischemia
Picture
RV Strain

INJURY AND NONSPECIFIC
  • Diffuse
  • May be shallow
  • May be deep and wide
  • May be associated with QT prolongation
  • Causes: ischemia; electrolyte abnormalities; drug toxicity; acute CNS event; catecholamine effect; pulmonary edema; massive PE

CARDIAC MEMORY
  • ​Seen in patients with intermittent wide complex rhythms: intermittent pacing, LBBB, WPW
  • When the QRS becomes narrow, T waves are inverted in those leads which had downgoing QRS complexes during the wide complex rhythm
  • Duration of memory Ts mimics duration of previous Wide complex rhythm
  • Frequently associated with prolonged QT

​The T waves are the most sensitive but least specific markers in the ECG!
​(almost anything can turn them down)
back to st segment
Move on to QT Interval
  • Home
    • About Us
    • EM GuideWire
    • CMC Ed Masters
    • Ped EM Morsels
  • Basics
  • P Waves
    • Sinus
    • Not sinus
    • Absent
  • PR interval
    • Short PR
    • Prolonged PR
    • Variable PR
  • QRS
    • Wide
    • Axis >
      • LAD
      • RAD
    • Amplitude >
      • High Voltage
      • Low Voltage
      • Alternans
    • R Wave Progression
    • Pathological Q waves
  • ST Segments
    • ST Elevation
    • ST Depression
  • T Waves
    • Flat, Bifid, or Notched
    • Inverted
  • QT intervals
    • Prolonged QT
    • Short QT
  • Patterns
    • STEMI
    • Pulmonary Embolism
    • Ventricular Hypertrophy
    • Pulmonary Disease
    • ST-T Patterns
    • Electrolyte Abnormalities
    • Cases >
      • Case 1
      • Case 2
      • Case 3
      • Case 4
      • Case 5
      • Case 6
      • Case 7
      • Case 8
      • Case 9
      • Case 10
      • Case 11
      • Case 12
      • Case 13
      • Case 14
      • Case 15
      • Case 16
      • Case 17
      • Case 18
      • Case 19
  • Interpreter