What does depressed t wave mean

If it is not possible on this basis to distinguish between T wave changes secondary to a life threatening disorder and T wave changes secondary to a non-life threatening disorder, diagnostic and therapeutic considerations directed towards the suspected life-threatening disorder should be arranged. If tall T waves are identified, two emergent considerations need be considered: the first is whether the T waves represent the hyperacute T waves of early ST elevation myocardial infarction.

This diagnosis is suggested by the recent within 30 minutes onset of ischemic symptoms. If in doubt, the diagnosis can sometimes be confirmed by repeating the ECG in 30 minutes; the repeat tracing will often demonstrate ST elevations. If hyperacute T waves of early ST elevation myocardial infarction are diagnosed, management should consist of urgent reperfusion and adjunct pharmacotherapies as outlined in the STEMI section. The second emergent consideration to be made in the setting of tall T waves is whether hyperkalemia is present.

If suspected, intravenous calcium gluconate should be administered which stabilizes the cardiac membrane. Further therapies directed towards hyperkalemia are outlined in the Hyperkalemia section.

If inverted T waves are identified and myocardial ischemia is suspected, appropriate management includes anti-ischemic therapy, anti-thrombotic therapy, and anti-platelet therapy as outlined in the Unstable Angina and Non-ST Elevation MI sections.

Cerebral T waves due to intracerebral hemorrhage or ischemic stroke mandate appropriate management as outlined in the respective chapters. Likewise, the management of pulmonary embolism and pericarditis are reviewed in respective chapters. The most common pitfall associated with interpretation of abnormalities of the T waves is not integrating the ECG findings with findings of history, physical examination, and selected laboratory and imaging studies to identify emergent conditions.

For example, a high-risk acute coronary syndrome can be present in the face of a normal ECG, and a flagrantly abnormal ECG with T wave inversions can be present without ischemia, attributable to multiple other diagnoses as above. Morris, F, Brady, WJ.. Part I. Channer, K, Morris, S. Slovis, C, Jenkins, R.. Ann Em Med. All rights reserved. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC.

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Register now at no charge to access unlimited clinical news, full-length features, case studies, conference coverage, and more. Jump to Section I. Diagnostic Approach. What is the differential diagnosis for this problem? Tall T waves Inverted T waves B. Historical information important in the diagnosis of this problem. Physical Examination maneuvers that are likely to be useful in diagnosing the cause of this problem. Laboratory, radiographic and other tests that are likely to be useful in diagnosing the cause of this problem.

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In patients with implanted right ventricular pacemakers, inverted T waves are most often seen in leads I and aVL. The T waves are inverted in an asymmetric fashion with a gradual initial downslope and an abrupt return to the baseline.

Perhaps the most sensitive system uses the summation of the negative component of the QRS complex in lead V1 and the positive component of the QRS complex in lead V6.

If the sum is greater than 35 mm in a patient older than 35 years, then the LVH by voltage pattern is diagnosed. Figure 2E. Left ventricular hypertrophy by voltage deviations and abnormal T waves. These inverted T waves have a gradual downsloping limb with a rapid return to the baseline. There may also be tall R waves in the right precordial leads, suggestive of a posterior wall acute MI; T-wave inversions are sometimes seen in these leads with prominent R waves Figure 2F.

Several different clinical entities present with inverted T waves. Since T-wave abnormalities in isolation have not been studied to any extent, little epidemiologic data exist that describe their prevalence in the ECGs of both normal populations and those at risk for cardiac events.

Nonetheless, an isolated T-wave inversion in a single lead is not abnormal and, in fact, is considered a normal variant finding. Other benign causes of T-wave inversion include the digitalis effect Figure 2G and the persistent juvenile T-wave pattern Figure 2H. Digitalis compounds have been implicated as a cause of T-wave inversions in otherwise healthy persons. The digitalis effect refers to ECG findings that are observed with therapeutic levels of the drug-it is not a toxic manifestation.

Persistent juvenile T-wave inversions may appear in the precordial leads eg, V1, V2, and V3 with an accompanying early repolarization pattern.

These findings may continue into adulthood, and some patients demonstrate persistent T-wave inversions in the precordial leads. January 30, William Brady, MD. The natural history of the inverted T wave is variable, ranging from a normal life without pathologic issues to sudden death related to Figure 1A. In general, an inverted T wave in a single lead in one anatomic segment ie, inferior, lateral, or anterior is unlikely to represent acute pathology; for instance, a single inverted T Figure 1B.

Electrophysiologic considerations: primary and secondary T-wave inversion Figure 1C. Wellens syndrome deeply inverted T wave The causes of T-wave inversions have commonly been grouped into 2 categories: primary T-wave changes and secondary T-wave changes. Figure 1D. An important subgroup of patients with pre-infarction Figure 2A.