T and U wave
Hyperacute T waves
Hyperacute T waves are tall, broad based and more symmetrical than normal. There is no absolute size that is too tall to be normal, as it depends on the size of the QRS. It has been suggested that a T:QRS ratio greater than 0.33 in V1-4 is abnormal. A T/R ratio has also been described. T waves in V4-6 should never be taller than the R wave. If in doubt, compare with a previous baseline ECG.
Hyperacute T waves can be the first sign of coronary occlusion. They localise to the affected artery distribution and can have reciprocal changes. They may also occur with Prinzmetal angina, or when the ST segments are on the way back down again after reperfusion.
- Hampton, J and Hampton, J (2019) - The ECG Made Easy, 9th edn, Elsevier
- Thaler, MS (2018) - The Only EKG Book You'll Ever Need, 9th edn, Lippincott Williams and Wilkins
- (2015) - ECG Interpretation Made Incredibly Easy!, 6th edn, Lippincott Williams & Wilkins
- Houghton, AR and Gray, D (2014) - Making Sense of the ECG: A Hands-on Guide, 4th edn, Taylor and Francis
- Wagner, GS and Strauss, DG (2013) - Marriott's Practical Electrocardiography, 12th edn, LWW
- Osmosis (2019) - ECG Cardiac Infarction and Ischemia | Osmosis, (Accessed: 07/09/2019)
- Strong Medicine (2014) - Intro to EKG Interpretation - Myocardial Infarctions (Part 1 of 2), (Accessed: 05/09/2019)
- Dr Smith's ECG Blog (2019) - Chest pain, pelvic and abdominal pain, hypotension, and severe ischemia on the ECG, (Accessed: 21/09/2019)
- Miranda, DF et al. (2018) - New Insights Into the Use of the 12-Lead Electrocardiogram for Diagnosing Acute Myocardial Infarction in the Emergency Department, Canadian Journal of Cardiology vol 34(2):132-145 (Accessed: 24/08/2019)
Groups of Signs
- Tall T waves:
Variations: T and U wave
This ECG is from a man in his 40s who presented with intermittent chest tightness, shortness of breath and diaphoresis.
This ECG shows ST elevation in V1-6 and hyperacute T waves out of proportion to the size of the QRS. There is terminal QRS distortion in V3. The cause was an acute proximal LAD occlusion.
This ECG is from an elderly male who presented with lethargy and pelvic pain. He was hypotensive (66/31), pulse 80.
This ECG shows widespread ST depression and reciprocal ST elevation in aVR due to diffuse subendocardial ischemia. The most likely cause was septic shock.
This ECG is from a man in his 50s who presented with acute chest pain.
This ECG shows anterior ST elevation with hyperacute T waves. The cause was a 100% proximal LAD occlusion.
This ECG is from a man in his 70s who presented with chest pain and nausea on a background of previous MI.
This ECG shows sinus rhythm with PVCs and subtle ST elevation in I, aVL and V2 and reciprocal ST depression in III and aVF. Angiogram was negative. The most likely cause was a brief LAD occlusion that spontaneously reperfused.
This ECG is from a man in his 40s who presented with chest pain since the previous evening, associated with vomiting and diaphoresis. He had recently stopped smoking.
This ECG shows subtle disproportionately tall T waves in V2-V3 and ST depression in V3-6 with slight ST elevation in V1. The cause was a 100% proximal LAD thrombotic occlusion.
This ECG is from a man in his 60s who presented with resolving chest pain.
This ECG shows hyperacute T waves in V2-4. The cause was an 80% obstruction of the LAD with a large thrombus. An earlier ECG showed ST segment elevation.
This ECG is from a woman in her 40s who presented with 'heartburn' overnight and then worsening chest pain 1 hour prior to arrival.
This ECG shows subtle MI with inferior and anterior hyperacute T waves and some reciprocal ST depression in aVL. The cause was a complete occlusion of a wraparound LAD.
This ECG is from a man in his 60s who presented with 3 hours of chest pain.
This ECG shows ST elevation and hyperacute T waves in V2 with inferior and lateral ST depression. The cause was acute LAD occlusion.
Where did they come from?
These ECGs were collected from Free Open Access Medical Education (#FOAMed) blogs, with the permission of their authors. You can find out more about each ECG's source by clicking on it.
Why are they here?
This is an experiment in digital curation. The idea is to collect resources to increase awareness and accessibility. Over time, more ECGs in the collection will be tagged to make it easier to find them and reused in new interactive quizzes.
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