Thread by @ekgdx

1/ Let’s talk about T waves #CardioTwitter

The T wave represents typically ventricular repolarization. It is the most labile wave on the EKG surface. 

Normal T wave

✅ Morphology: Asymmetric.
✅ Amplitude: ≤6 mm in limb leads and ≤10 mm in precordial leads.

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2/ Tall upright T wave

Tall upright T waves are usually characterized by tall and peaked shape. 

✅ Amplitude: >6 mm in limb leads and >10 mm in precordial leads.

Causes: Hyperkalemia, hyperacute MI, normal variant, prinzmetal angina, aortic stenosis, LVH, RVH, others. 

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3/ Notched T wave

Possible causes: May be caused by morphological changes in the cardiomyocytes' action potential waveforms. Another causes include: Drugs (such as Dofetilide, Quinidine, Ranolazine, Verapamil), long QT syndrome, athletes, others.

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4/ Inverted T wave

Causes: Myocardial ischemia (acute or chronic), MI, BBB, hypertrophic cardiomyopathy, PE, raised intracranial pressure, persistent juvenile T wave, normal finding in children, LVH, RVH, others. 

Isolated T wave inversion in lead III can be a normal variant.

5/ Biphasic T wave

Biphasic T wave can be with "terminal positivity (down-up)" or "terminal negativity (up-down)".

Causes: Myocardial ischemia, hypokalemia, reperfusion phase, others.

If biphasic T wave with terminal negativity is present in V2-V3, consider Wellens type I.

6/ Giant Inverted T wave

✅ Morphology: Giant and symmetrical.
✅ Amplitude: ≥10 mm. 

Causes: Severe ischemia, pheochromocytoma, electroconvulsive therapy, brain bleed, cocaine abuse, post-pacemaker syndrome, apical hypertrophic cardiomyopathy, others. 

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7/ Hyperacute T wave

Hyperacute T wave have been reported in association with acute myocardial ischemia due to critical stenosis or occlusion of a coronary artery that may occur in the very early phases of myocardial infarction within the 30 minutes of onset of symptoms.

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8/ The EKGs are courtesy of EKGDX App.

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