d o
t o r e g . c o m
Dr. Mete ALPASLAN
T Wave
T wave represents ventricular repolarization. During ventricular repolarization, myocardial cells become negative again and ready themselves for the next depolarization.
Normally the T wave is in the same direction with QRS complex. In leads with a positive (upright) QRS complex, the T wave is also expected to be positive. In leads with a negative QRS complex, the T wave is also expected to be negative.
Usually the T wave is negative in lead aVR.
In healthy adults over 20 years of age, T wave is expected to be positive in leads
I, II, and from
V3 to V6.
Normally the T wave has a blunted apex.
Normally T wave is not symmetric. Proximal half is shallow than the distal half.
Mechanical systole starts with ventricular depolarization (QRS complex). On the contrary, ventricular repolarization does not result in any mechanical event. Systole starts with QRS complex and lasts till the end of T wave.
T wave is the most labile component of the ECG. Even hyperventilation may result in T wave negativity.
The amplitude of T wave decreases with aging.
Definitions of T waves in leads I, II, aVF, V2-V6 (proposed by the A.H.A.)
Ischemia (symmetrically negative T waves)
Causes of negative T waves
Ischemia (symmetrically negative T waves)
Misplacement of chest electrodes (frequent). Incorrect placement of leads V2 and/or V3 may result in negative T waves confined to either lead V2 or lead V3.
Juvenile T pattern
Right ventricular overload (acute pulmonary embolism, chronic pulmonary disease)
Early repolarization (sometimes negative T waves may accompany the ST elevation)
Hyperventilation
As juvenile T pattern in leads V1-V3 in well-trained athletes
Cardiomyopathies (including hypertrophic cardiomyopathy and the arrhythmogenic right ventricular dysplasia)
After an attack of paroxysmal tachycardia
Cerebrovascular accidents
Intermittent left bundle branch block
After artifically pacing the heart with a pacemaker
WPW syndrome
After truncal vagotomy (%9)
Prominent T waves in chest leads may be due to
Early repolarization
Hyperacute stage of acute anterior myocardial infarction
Acute posterior myocardial infarction
Prinzmetal angina (vasospastic angina)
Hyperkalemia
Cerebrovascular accidents
Juvenile T pattern
The presence of negative T wave in leads C1 (V1) to C3 (V3).
Since it is frequently observed in children under 12 years of age, it is called "
juvenile T pattern".
Usually, the juvenile T pattern is expected to disappear after the age of 20.
If this T negativity persists in apparently healthy adults with no cardiac disease, it is called "persistent juvenile T pattern".
Persistent juvenile T pattern is more frequent in women.
A negative T wave in lead C1 (V1) is a normal finding in adults and should not be labeled as "persistent juvenile T pattern".
References
Circulation 2009;119;e241-e250.
Eur Heart J 2009;30:1728-35.
JAMA 1970;211:798-801.
The surface electrocardiography in ischemic heart disease: clinical and imaging correlations and prognostic implications / A. Bay´es de Luna, M. Fiol-Sala. Blackwell Futura 2008.
ECG 1. The presence of negative T waves in leads aVR and/or C1 (V1) is accepted as normal.
Click here for a more detailed ECG
ECG 2. The ECG above belongs to a 50 years old woman.
T wave negativity in leads C1-C4 is due to persistent juvenile T pattern. Her coronary arteries are normal.
Click here for a more detailed ECG
ECG 3. Prominent T waves in leads C2 and C3. is due to early repolarization in the above ECG of a 25 years-old man.
Click here for a more detailed ECG
ECG 4. The ECG above belongs to a hypertensive woman with normal coronary arteries and shows anterolateral T wave
negativity and upsloping ST segment depression in leads V4 to V6 .
Click here for a more detailed ECG
ECG 5a. The ECG above belongs to a 53 years-old man and is recorded within the first hour of acute anterior myocardial
infarction. There are prominent T waves in anterior leads and ST segment elevation accompanies. The prominent T waves
which are observed during the first minutes of acute infarction are called as hyperacute T waves and are not seen in late
admitting patients.
ECG 5b. Above is his ECG, recorded one day later. T wave amplitude (height) has decreased and amplitude of the ST segment
elevation has also decreased . Additionally, the presence of QS complex in leads V2-V4 show that the acute phase of anterior
myocardial infarction is over.
Click here for a more detailed ECG
ECG 6. The ECG above belongs to a 56 years-old woman with normal coronary arteries. There is widespread T wave negativity
in the anterior leads. The asym metric appearance of T waves suggests that it is NOT ISCHEMIC in origin:
The first half is more gradual while the second half is more steep .
Click here for a more detailed ECG
ECG 7a. Above is an ECG from an apparently healthy middle-aged man.
He does not have any cardiac symptom.
Only lead V3 shows negative T waves.
Bu durumda, ilk önce V2 ile V3 elektrodlarının göğüs üzerine yanlış yerleştirilmiş olabileceği düşünülmelidir.
Click here for a more detailed ECG
ECG 7b. The ECG above belongs to the same patient.
It was recorded after correct placement of lead V2 and lead V3 electrodes.
Negative T waves are not seen in lead V3 any more.
Click here for a more detailed ECG
T wave represents ventricular repolarization. During ventricular repolarization, myocardial cells become negative again and ready themselves for the next depolarization.
Normally the T wave is in the same direction with QRS complex. In leads with a positive (upright) QRS complex, the T wave is also expected to be positive. In leads with a negative QRS complex, the T wave is also expected to be negative.
Usually the T wave is negative in lead aVR.
In healthy adults over 20 years of age, T wave is expected to be positive in leads
I, II, and from
V3 to V6.
Normally the T wave has a blunted apex.
Normally T wave is not symmetric. Proximal half is shallow than the distal half.
Mechanical systole starts with ventricular depolarization (QRS complex). On the contrary, ventricular repolarization does not result in any mechanical event. Systole starts with QRS complex and lasts till the end of T wave.
T wave is the most labile component of the ECG. Even hyperventilation may result in T wave negativity.
The amplitude of T wave decreases with aging.
Definitions of T waves in leads I, II, aVF, V2-V6 (proposed by the A.H.A.)
Ischemia (symmetrically negative T waves)
Causes of negative T waves
Ischemia (symmetrically negative T waves)
Misplacement of chest electrodes (frequent). Incorrect placement of leads V2 and/or V3 may result in negative T waves confined to either lead V2 or lead V3.
Juvenile T pattern
Right ventricular overload (acute pulmonary embolism, chronic pulmonary disease)
Early repolarization (sometimes negative T waves may accompany the ST elevation)
Hyperventilation
As juvenile T pattern in leads V1-V3 in well-trained athletes
Cardiomyopathies (including hypertrophic cardiomyopathy and the arrhythmogenic right ventricular dysplasia)
After an attack of paroxysmal tachycardia
Cerebrovascular accidents
Intermittent left bundle branch block
After artifically pacing the heart with a pacemaker
WPW syndrome
After truncal vagotomy (%9)
Prominent T waves in chest leads may be due to
Early repolarization
Hyperacute stage of acute anterior myocardial infarction
Acute posterior myocardial infarction
Prinzmetal angina (vasospastic angina)
Hyperkalemia
Cerebrovascular accidents
Juvenile T pattern
The presence of negative T wave in leads C1 (V1) to C3 (V3).
Since it is frequently observed in children under 12 years of age, it is called "
juvenile T pattern".
Usually, the juvenile T pattern is expected to disappear after the age of 20.
If this T negativity persists in apparently healthy adults with no cardiac disease, it is called "persistent juvenile T pattern".
Persistent juvenile T pattern is more frequent in women.
A negative T wave in lead C1 (V1) is a normal finding in adults and should not be labeled as "persistent juvenile T pattern".
References
Circulation 2009;119;e241-e250.
Eur Heart J 2009;30:1728-35.
JAMA 1970;211:798-801.
The surface electrocardiography in ischemic heart disease: clinical and imaging correlations and prognostic implications / A. Bay´es de Luna, M. Fiol-Sala. Blackwell Futura 2008.
ECG 1. The presence of negative T waves in leads aVR and/or C1 (V1) is accepted as normal.
Click here for a more detailed ECG
ECG 2. The ECG above belongs to a 50 years old woman.
T wave negativity in leads C1-C4 is due to persistent juvenile T pattern. Her coronary arteries are normal.
Click here for a more detailed ECG
ECG 3. Prominent T waves in leads C2 and C3. is due to early repolarization in the above ECG of a 25 years-old man.
Click here for a more detailed ECG
ECG 4. The ECG above belongs to a hypertensive woman with normal coronary arteries and shows anterolateral T wave
negativity and upsloping ST segment depression in leads V4 to V6 .
Click here for a more detailed ECG
ECG 5a. The ECG above belongs to a 53 years-old man and is recorded within the first hour of acute anterior myocardial
infarction. There are prominent T waves in anterior leads and ST segment elevation accompanies. The prominent T waves
which are observed during the first minutes of acute infarction are called as hyperacute T waves and are not seen in late
admitting patients.
ECG 5b. Above is his ECG, recorded one day later. T wave amplitude (height) has decreased and amplitude of the ST segment
elevation has also decreased . Additionally, the presence of QS complex in leads V2-V4 show that the acute phase of anterior
myocardial infarction is over.
Click here for a more detailed ECG
ECG 6. The ECG above belongs to a 56 years-old woman with normal coronary arteries. There is widespread T wave negativity
in the anterior leads. The asym metric appearance of T waves suggests that it is NOT ISCHEMIC in origin:
The first half is more gradual while the second half is more steep .
Click here for a more detailed ECG
ECG 7a. Above is an ECG from an apparently healthy middle-aged man.
He does not have any cardiac symptom.
Only lead V3 shows negative T waves.
Bu durumda, ilk önce V2 ile V3 elektrodlarının göğüs üzerine yanlış yerleştirilmiş olabileceği düşünülmelidir.
Click here for a more detailed ECG
ECG 7b. The ECG above belongs to the same patient.
It was recorded after correct placement of lead V2 and lead V3 electrodes.
Negative T waves are not seen in lead V3 any more.
Click here for a more detailed ECG