Inverted T waves

Inverted T waves are upside-down. They can be normal in children. If abnormal they may be caused by ischemia, infarction, strain patterns, bundle branch blocks or raised intracranial pressure.

T waves may be inverted in III, aVL and/or V1. T waves should not be negative in I, II, V5 and V6. T inversion in V2 is common in young women and normal in 1% of young men <30.

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In the ECGquest archives, this ECG has been tagged with: - 12-Lead Inverted T waves Acute right heart strain Pulmonary embolism Dr Smith's ECG Blog CC BY-NC
A young woman with altered mental status and hypotension

This ECG is from a woman in her 30s who presented with altered mental status and syncope. She was hypotensive and tachycardic.

This ECG shows sinus tachycardia with concave ST segments and domed inverted T waves V1-3, consistent with acute right heart strain caused by large bilateral Pulmonary Emboli.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Inverted T waves Acute right heart strain Pulmonary embolism Dr Smith's ECG Blog CC BY-NC
A young woman with altered mental status and hypotension: Case 2

This ECG is from a patient of unknown age who presented with sudden chest pain and shortness of breath.

This ECG shows domed inverted T waves V1-3, consistent with acute right heart strain caused by Pulmonary Emboli.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Deeply inverted T waves Inferior ST elevation Inverted T waves Inverted U waves Lateral ST elevation Dr Smith's ECG Blog CC BY-NC
Bizarre T-wave inversions, with Negative U-waves and Very long QT. And a myocardial viability study.

This ECG is from a man in his 60s who developed hypokalemia during a complicated hospital admission including GI bleed and anaemia.

This ECG shows inverted T waves and inverted U waves with a very prolonged QT. There is subtle ST elevation in inferior and lateral leads. Troponin was elevated, echo showed regional wall motion abnormalities apical and anteriorly. Angiogram showed severe multivessel disease and an apical LAD occlusion of uncertain age. The most likely cause was either a small infarction or takotsubo.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Inverted T waves Myocarditis Dr Smith's ECG Blog CC BY-NC
What does this ECG with significant ST Elevation represent?

This ECG is from a man in his 30s who presented with a week of chest pain.

This ECG shows T wave inversion in V5-6 with J point notching and a short QT interval. Echo showed global hypokinesis and mild-mod systolic dysfunction. Troponin was elevated. Angiogram was normal. The diagnosis was myocarditis.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Inverted T waves Normal Sinus Rhythm Premature atrial complex Acute right heart strain Pulmonary embolism Dr Smith's ECG Blog CC BY-NC
An elderly woman transferred to you for chest pain, shortness of breath, and positive troponin – does she need the cath lab now?

This ECG is from an elderly woman who presented with sudden onset shortness of breath after months of inactivity due to a back injury.

This ECG shows sinus tachycardia with large inverted T waves, consistent with right heart strain. The cause was a very large PE.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Anterior ST depression Inverted T waves R in V1 RVH Dr Smith's ECG Blog CC BY-NC
ST Depression and T-wave inversion in V2 and V3.

This ECG is from a middle aged male dialysis patient who was found disorganised and paranoid.

This ECG shows ST depression and T wave inversion in V2-3 due to right ventricular hypertrophy.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Bradycardia Inverted T waves Vertical axis Sinus bradycardia ECG of the Week CC-BY-NC-SA
ECG of the Week – 28th January 2019 – Interpretation

This ECG is from a teenage girl who presented with ongoing weight loss (BMI 13) and a known eating disorder.

This ECG shows sinus bradycardia (36) and T wave inversion in V1-2 and aVL.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Inverted T waves Tall QRS Normal Dr Smith's ECG Blog CC BY-NC
15 yo AAM with ST Elevation and T-wave Inversion. Hypertrophic Cardiomyopathy or Normal (“Variant”)?

This ECG is from a teenage male who presented for a routine sports physical. He is African American.

This ECG shows high voltage with benign T wave inversion. Echocardiography did not show any evidence of HOCM.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Inverted T waves Dr Smith's ECG Blog CC BY-NC
Intermittent increasing exertional chest pain and serial negative troponins

This ECG is from a woman in her 40s who presented with intermittent chest pain on exertion over the past 2 weeks. This was the initial ECG when she was pain free.

This ECG shows an inverted T wave in III with slight ST depression V3-6. Troponins were negative. Repeat ECG showed dynamic ST segments. Angiography showed a 95% stenosis of the distal RCA.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Paediatric Inverted T waves Normal Axis Tall QRS Normal Sinus Rhythm Normal ECG Guru CC-BY-NC-SA
Instructors’ Collection ECG: Normal ECG in Seven-year-old Girl

This ECG is from a young girl with mild chest pain.

This ECG shows normal sinus rhythm with inverted T waves in V1 and a tall QRS complex. This was a normal paediatric ECG.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Inverted T waves J wave Tall QRS Normal Sinus Rhythm Normal Dr Smith's ECG Blog CC BY-NC
Two cases of ST Elevation with Terminal T-wave Inversion – do either, neither, or both need reperfusion?

This ECG is from a teenage male who presented with chest tightness and shortness of breath for 6 hours on a background of asthma.

This ECG shows sinus rhythm with tall QRS and associated repolarisation changes, benign T wave inversion in V3-V6 with J-waves and ST-elevation.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Bradycardia Inverted T waves Normal Axis Regular ECG of the Week CC-BY-NC-SA
ECG of the Week – 3rd December 2018 – Interpretation

This ECG is from a man in his 50s who had an episode of chest pain and shortness of breath. This ECG was recorded when he was pain free.

This ECG shows sinus bradycardia with T wave inversion in the inferior leads, which was caused by reperfusion of a critical stenosis of the RCA.

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