T waves

Question 1

In which leads are T waves normally inverted?

Answer 1

aVR and V1

Question 2

What is the normal height of T waves in limb leads and chest leads?

Answer 2

≤ 5 mm in limb leads; ≤ 10 mm in chest leads

Question 3

What does a broad, symmetrically peaked T wave suggest?

Answer 3

Hyperacute T wave, early ischemia

Question 4

What are some normal or benign causes of inverted T waves?

Answer 4

In children and persistent juvenile pattern

Question 5

causes of inverted T waves

Answer 5

• Normal in children / persistent juvenile pattern
  
  • BBB
  • Ventricular hypertrophy (strain pattern):
  • LVH: T inversion in I, aVL, V5–V6
  • RVH: T inversion in inferior leads & V1–V3
  • Pulmonary embolism (similar to RVH)
  • HOCM → deep T in all chest leads
  • Raised ICP
  • MI / infarction

Question 6

What cardiac conduction abnormality can cause inverted T waves?

Answer 6

Bundle Branch Block (BBB)

Question 7

How does ventricular hypertrophy cause T wave inversion?

Answer 7

LVH: T inversion in I, aVL, V5–V6; RVH: T inversion in inferior leads and V1–V3

Question 8

What pulmonary condition can mimic RVH pattern with inverted T waves?

Answer 8

Pulmonary embolism (PE)

Question 9

What cardiomyopathy causes deep T wave inversion in all chest leads?

Answer 9

Hypertrophic Obstructive Cardiomyopathy (HOCM)

Question 10

What neurologic condition can cause T wave inversion?

Answer 10

Raised intracranial pressure (ICP)

Question 11

What ischemic condition leads to inverted T waves?

Answer 11

Myocardial infarction (MI)

Question 12

How do biphasic T waves appear in ischemia?

Answer 12

T waves go up then down

Question 13

How do biphasic T waves appear in hypokalemia?

Answer 13

T waves go down then up

Question 14

What is a ‘camel hump’ T wave, and what causes it?

Answer 14

A double peak T wave caused by hidden P waves, tachycardia, or heart block

Question 15

What does a flattened T wave typically indicate?

Answer 15

Ischemia

Question 16

What does it mean if the T wave in V1 is larger than in V6?

Answer 16

High suspicion of myocardial disease

Question 17

What does the presence of new upright T waves in V1 indicate?

Answer 17

84% specificity for ischemic heart disease (IHD)

Question 18

Loss of Precordial T Wave Progression

Answer 18

• Normally T waves should increase across precordial leads
  
  • If T in V1 is larger than in V6 → high suspicion of myocardial disease
  • All new upright T waves in V1 → 84% specificity for IHD