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ECG - ST-T T waves changes
Related Subjects: |ECG Basics |ECG Axis |ECG Analysis |ECG LAD |ECG RAD |ECG Low voltage |ECG Pathological Q waves |ECG ST/T wave changes |ECG LBBB |ECG RBBB |ECG short PR |ECG Heart Block |ECG Asystole and P wave asystole |ECG QRS complex |ECG ST segment |ECG: QT interval |ECG: LVH |ECG RVH |ECG: Bundle branch blocks |ECG Dominant R wave in V1 |ECG Acute Coronary Syndrome |ECG Crib sheets
📖 T Waves
- ⚡ The T wave represents ventricular repolarisation.
- 🧭 Normally, T waves are concordant with the QRS (same direction), except in aVR and V1 where inversion can be normal.
⚠️ Abnormal T Wave Patterns
- 📈 Peaked T waves: Classic for hyperkalaemia (tall, narrow, “tent-shaped”).
- ⬇️ Flattened T waves: Seen in hypokalaemia, hypothyroidism, obesity, COPD.
- ⬇️⬇️ Deep T wave inversion:
- Acute Coronary Syndrome (ischaemia)
- Left Ventricular Hypertrophy (strain pattern)
- Left Bundle Branch Block
- Hypertrophic Cardiomyopathy
- 🔺 Deep anterior T wave inversion: LAD stenosis, Subarachnoid haemorrhage (neurogenic T waves), Takotsubo cardiomyopathy.
- 🔻 Deep inferior T wave inversion: Suggests RCA stenosis.
🛠️ Action
- 🧪 Always check electrolytes (K⁺, Mg²⁺, Ca²⁺) and correct if abnormal.
- 📉 Consider ischaemia if inversion is new, deep, or localized to vascular territories.
- 🧠 Think of extra-cardiac causes (e.g. SAH, stress-induced cardiomyopathy) if distribution is atypical.
💡 Teaching Pearls
✔️ Hyperkalaemia ➝ tall tented T waves are often the first ECG change (progress to sine-wave if severe). ✔️ Hypokalaemia ➝ flat T + U waves. ✔️ Deep T inversion in anterior leads can be ischaemic or neurogenic - always interpret in context!
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