T and U wave
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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Groups of Signs
Variations: T and U wave
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.
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.
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.
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.
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.
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.
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.
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.
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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