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ECG Basics

The T Wave

February 15th, 2021


The T wave on an ECG trace is indicative of ventricular repolarisation.
  • Look For

  • A deflection following the QRS complex that is normally asymmetrical, with a slow upslope and a rapid downslope. Usually positive, though negative T waves are normal in aVR and V1.

T Wave Flattening

  • Look For

  • Flat T waves with amplitude between +1mm to -1mm.
  • Causes of T Wave Flattening

  • Myocardial ischaemia
  • Hypokalaemia
  • Example

  • ST depression, flattened T waves and prolonged QT interval associated with hypokalaemia:
  • T Wave Flattening

T Wave Inversion

  • Look For

  • Negative T waves with amplitude >1mm.
  • T Wave Inversion
  • Causes of T Wave Inversion

  • Myocardial ischaemia / infarctionNarrow, symmetric, 'coved' T wave inversion
  • Physiological in children
  • Pulmonary embolism
  • Myocarditis
  • Pericarditis
  • Bundle branch block
  • Left ventricular hypertrophy
  • Hypertrophic cardiomyopathy
  • Stroke

Tall T Waves

  • Look For

  • T wave prominence. Note whether the T waves are symmetrical or asymmetrical.
  • Causes of Tall T Waves

  • Hyperkalaemia
  • Benign early repolarisation
  • Myocardial infarction
  • Interpretation

  • Narrow, symmetrical 'tented' T waves - suggestive of hyperkalaemia
  • Tall T waves with concave ST elevation in the precordial leads - suggestive of benign early repolarisation
  • Prominent, symmetrical and pointed ('hyperacute') T waves - suggestive of myocardial infarction
  • Example

  • "Tented" T waves associated with mild hyperkalaemia:
  • Tall T Waves
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