Inverted U waves are abnormal in any lead where the T waves are upright. Causes include ischemia, volume overload, hypertension, hyperthyroidism, cardiomyopathy and congenital heart disease.
See also: T and U waves
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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.