Biphasic T waves

Biphasic T waves can be either down-up or up-down in shape.

Some up-down biphasic T waves are known as Wellen’s waves.

Down-up biphasic T waves can be caused by infarction with some reperfusion / post-ischemia or hypokalemia.

See also: T and U waves

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References

ECG Library (29)

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In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Nonspecific baseline artefact Biphasic T waves Normal Axis Dr Smith's ECG Blog CC BY-NC
Dynamic, Reversible, Ischemic T-wave inversion mimics Wellens’. All trops negative.

This ECG is from a middle aged man who presented with intermittent chest tightness and nausea on walking that resolved with rest. This had happened twice over the past two days. He was likely pain free at the time that this ECG was recorded.

This ECG shows terminal T wave inversion in V2-4, resembling Wellens' waves. There was no wall motion abnormality on echo and troponins were negative (so it was not a true Wellens' syndrome), but a stress echo was markedly positive. Angiogram showed a 95% LAD stenosis and 70% first diagonal stenosis. The cause of the T wave changes was likely ischemia without infarction, ie. unstable angina.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Serial 12-lead Biphasic T waves Left Axis Deviation Sinus bradycardia Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
A Tale of 2 Occlusions in the Same Patient: one with Expert ECG interpretation, the Other Without – post-intervention ECG

This ECG is from a man in his 40s who presented with chest discomfort and diaphoresis since waking a few hours earlier, on a background of prior infarction with PCI years ago, active smoking, high cholesterol and hypertension. This was the repeat ECG post-intervention.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Serial 12-lead Biphasic T waves Left Axis Deviation Sinus bradycardia Dr Smith's ECG Blog CC BY-NC
A Tale of 2 Occlusions in the Same Patient: one with Expert ECG interpretation, the Other Without – repeat ECG on day 2

This ECG is from a man in his 40s who presented with chest discomfort and diaphoresis since waking a few hours earlier, on a background of prior infarction with PCI years ago, active smoking, high cholesterol and hypertension. This was the repeat ECG on day 2.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Serial 12-lead Biphasic T waves Proximal LAD occlusion Dr Smith's ECG Blog CC BY-NC
How can you persuade your cardiologist to take a Non-STEMI patient to the cath lab emergently? – post PCI
In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST elevation Biphasic T waves ST elevation in aVL Proximal LAD occlusion Dr Smith's ECG Blog CC BY-NC
A 50-Something w Chest Pain, Anterior STE, and no Evolution on 3 Serial ECGs over 30 minutes, (-) POCUS. Repeat ECG next day.
In the ECGquest archives, this ECG has been tagged with: - 12-Lead Serial 12-lead Anterior ST elevation Biphasic T waves Normal ST elevation Dr Smith's ECG Blog CC BY-NC
2 Cases of Resolved Chest Pain with Dynamic Terminal T-wave Inversion: case 1 later, still pain free
In the ECGquest archives, this ECG has been tagged with: - 12-Lead Serial 12-lead Biphasic T waves Wellens Waves Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
2 Cases of Resolved Chest Pain with Dynamic Terminal T-wave Inversion: case 2
In the ECGquest archives, this ECG has been tagged with: - 12-Lead Serial 12-lead Biphasic T waves Wellens Waves Dr Smith's ECG Blog CC BY-NC
2 Cases of Resolved Chest Pain with Dynamic Terminal T-wave Inversion: case 2, 6h later