These inverted T waves have a gradual downsloping limb with a rapid return to the baseline. There may also be tall R waves in the right precordial leads, suggestive of a posterior wall acute MI; T-wave inversions are sometimes seen in these leads with prominent R waves Figure 2F.
Several different clinical entities present with inverted T waves. Since T-wave abnormalities in isolation have not been studied to any extent, little epidemiologic data exist that describe their prevalence in the ECGs of both normal populations and those at risk for cardiac events. Nonetheless, an isolated T-wave inversion in a single lead is not abnormal and, in fact, is considered a normal variant finding.
Other benign causes of T-wave inversion include the digitalis effect Figure 2G and the persistent juvenile T-wave pattern Figure 2H. Digitalis compounds have been implicated as a cause of T-wave inversions in otherwise healthy persons. The digitalis effect refers to ECG findings that are observed with therapeutic levels of the drug-it is not a toxic manifestation.
Persistent juvenile T-wave inversions may appear in the precordial leads eg, V1, V2, and V3 with an accompanying early repolarization pattern. These findings may continue into adulthood, and some patients demonstrate persistent T-wave inversions in the precordial leads. January 30, William Brady, MD. The natural history of the inverted T wave is variable, ranging from a normal life without pathologic issues to sudden death related to Figure 1A.
In general, an inverted T wave in a single lead in one anatomic segment ie, inferior, lateral, or anterior is unlikely to represent acute pathology; for instance, a single inverted T Figure 1B. Electrophysiologic considerations: primary and secondary T-wave inversion Figure 1C. Wellens syndrome deeply inverted T wave The causes of T-wave inversions have commonly been grouped into 2 categories: primary T-wave changes and secondary T-wave changes.
Figure 1D. An important subgroup of patients with pre-infarction Figure 2A. Deeper T-wave inversions-attributed to acute right ventricular strain and occasionally seen in patients with massive PE-are generally Figure 2B. Inflammatory causes Acute myocarditis and acute myopericarditis can present with a range of ECG abnormalities, including ST-segment elevation and T-wave inversion. Neurogenic causes There are a number of neurogenic causes of primary T-wave inversions. Bundle-branch block and ventricular paced implanted pacemaker patterns Bundle-branch block Figure 2C and ventricular paced Figure 2D; implanted pacemaker patterns produce a number of abnormalities of the ST segment and T wave.
In right bundle-branch block pattern, Figure 2D. Left ventricular hypertrophy by voltage Left ventricular hypertrophy LVH by voltage pattern can be described via numerous ECG scoring systems. The positive turn of the T waves during exercise occurs in a similar fashion in people with or without cardiomyopathy, and, as such, the test is of limited clinical usefulness.
The electrocardiographic anomalies could represent the first manifestation of a subtle pathologic condition, which will become apparent at a later time, so that repeated periodic examinations are necessary.
For athletes, diagnostic work up may vary according to the different manifestations: Asymptomatic athlete, TWI, and evidence of cardiomyopathy: refrain from agonistic activities; genetic testing also for the immediate family. Asymptomatic athlete, TWI, and no evidence of cardiomyopathy or positive family history: no limitation to sport activities, possible genetic testing, careful attention to symptoms occurrence, annual check-ups, possible electrocardiography, and echocardiography for the first degree relatives.
Asymptomatic athlete, TWI, and uncertain evidences of cardiomyopathy and no family history: no limitation to sport activities, possible genetic testing, careful attention to symptoms occurrence, annual check-ups, possible electrocardiography, and echocardiography for the first degree relatives. Asymptomatic athlete, TWI, and uncertain evidences of cardiomyopathy and positive family history:.
Recommendations for interpretation of lead electrocardiogram in the athlete. Eur Heart J ; 31 : — Google Scholar. Br J Sports Med ; 47 : — Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search.
Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Prominent U waves due to severe hypokalaemia. Hidden P waves in sinus tachycardia.
Hidden P waves in marked 1st degree heart block. Hidden P waves in 2nd degree heart block with conduction. Dynamic T wave flattening due to anterior ischaemia. T waves return to normal as ischaemia resolves. EKG Library. Ed Burns.
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