T wave inversion: Difference between revisions
(30 intermediate revisions by 2 users not shown) | |||
Line 3: | Line 3: | ||
{{CMG}} | {{CMG}} | ||
{{SK}} negative T wave; negative T waves; inverted Ts;flipped T waves; flipped T wave; flipped Ts | |||
==Overview== | ==Overview== | ||
T wave inversion is a non-specific electrocardiographic sign. | [[T wave]] inversion is a non-specific electrocardiographic sign in which the T wave, an electrical signal that occurs when the heart is repolarizing or recharging itself, it is upside down instead of upright. | ||
==Classification== | |||
===Primary T Wave Inversion=== | |||
These changes in the T wave represent a primary abnormality in electrical repolarization (i.e. they are not due to or secondary to a change in conduction). Examples include the [[dig effect]], [[myocardial ischemia]] or central nervous system events such as [[subarachnoid hemorrhage]]. | |||
===Secondary T Wave Inversion=== | |||
The [[T wave]] may be inverted as a result of changes in the sequence of ventricualr activation such as is seen with [[premature ventricular contractions]] ([[PVCs]]), [[left bundle branch block]], [[right bundle branch block]] ([[RBBB]]) and pre excitation syndromes like [[WPW]]. | |||
==Causes== | ==Causes== | ||
*[[Arrhythmogenic RV dysplasia]] should be suspected in this cohort if the T wave inversion persists beyond lead V<sub>1</sub> in a post pubertal male athlete | |||
*[[Cerebrovascular accident]]s can cause deep widely splayed T waves referred to as [[cerebral T waves]] | |||
*[[Digoxin effect]] or [[Dig effect]] | |||
*[[Electrolyte disturbance]] | *[[Electrolyte disturbance]] | ||
*[[Ischemic heart disease]] | *[[Ischemic heart disease]] including [[non ST segment elevation MI]] or prior [[MI]] | ||
*[[Left ventricular strain]] | *[[Left bundle branch block]], it is normal for the T wave to be inverted if the QRS complex is upright | ||
*[[Left ventricular hypertrophy with strain]] | |||
*[[Myocarditis]] | |||
*[[Persistent juvenile T-wave pattern]] | |||
*[[Premature ventricular contraction]] | |||
*[[Pulmonary embolism]], particularly in the anterior precordium | |||
*[[Restrictive cardiomyopathy]] | |||
*[[Subarachnoid hemorrhage]] | |||
*[[Unstable angina]] | |||
*[[Wellens' syndrome]] | |||
*[[Wolff-Parkinson-White syndrome]] ([[WPW]]) | |||
===Causes by Organ System=== | |||
{|style="width:80%; height:100px" border="1" | |||
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' | |||
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Acute pericarditis]], [[Advanvced AV block]], [[Angina]], [[Arrhythmogenic right ventricular dysplasia]], [[Atrioventricular reentry tachycardia with orthodromic conduction]], [[Bundle branch block]], [[Global T-wave inversion]], [[Hypertrophic cardiomyopathy]], [[Memory T-wave phenomenon]], [[Myocardial infarction]], [[Myocardial ischemia]], [[Myocarditis]], [[Persistent juvenile T-wave pattern]], [[Pre-excitation syndrome]], [[Pulmonary embolism]], [[Restrictive cardiomyopathy]], [[Stress cardiomyopathy]], [[Takotsubo cardiomyopathy]], [[Ventricular ectopic beats]], [[Ventricular hypertrophy with strain]], [[Wellens' syndrome]], [[WPW syndrome]], [[Brugada syndrome]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Chemical / poisoning''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Dermatologic''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Drug Side Effect''' | |||
|bgcolor="Beige"| [[Cocaine]], [[Digitalis]], [[Digoxin]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Ear Nose Throat''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Endocrine''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Environmental''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Gastroenterologic''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Genetic''' | |||
|bgcolor="Beige"| [[Brugada syndrome]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Hematologic''' | |||
|bgcolor="Beige"| [[Anemia]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Iatrogenic''' | |||
|bgcolor="Beige"| [[After surgery]], [[Ventricular paced beats]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Infectious Disease''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Musculoskeletal / Ortho''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Neurologic''' | |||
|bgcolor="Beige"| [[Cerebrovascular accident]], [[Intracranial hemorrhage]], [[Raised intracranial pressure]], [[Status epilepticus]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Nutritional / Metabolic''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Obstetric/Gynecologic''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Oncologic''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Opthalmologic''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Overdose / Toxicity''' | |||
|bgcolor="Beige"| [[Cocaine]], [[Digitalis]], [[Digoxin]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Psychiatric''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Pulmonary''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Renal / Electrolyte''' | |||
|bgcolor="Beige"| [[Electrolyte abnormalities]], [[Hypokalemia]] | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Rheum / Immune / Allergy''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Sexual''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Trauma''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Urologic''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Dental''' | |||
|bgcolor="Beige"| No underlying causes | |||
|- | |||
|-bgcolor="LightSteelBlue" | |||
| '''Miscellaneous''' | |||
|bgcolor="Beige"| [[Cocaine]], [[After meals]], [[Fever]], [[Hyperventilation]], [[Lead aVR of normal ECG]], [[Normal finding in children]], [[Normal variant of repolarization]], [[Standing]] | |||
|- | |||
|} | |||
===Causes in Alphabetical Order=== | |||
{{MultiCol}} | |||
*[[Acute pericarditis]] | |||
*[[Advanvced AV block]] | |||
*[[After meals]] | |||
*[[After surgery]] | |||
*[[Anemia]] | |||
*[[Angina]] | |||
*[[Arrhythmogenic right ventricular dysplasia]] | |||
*[[Atrioventricular reentry tachycardia with orthodromic conduction]] | |||
*[[Brugada syndrome]] | |||
*[[Bundle branch block]] | |||
*[[Cerebrovascular accident]] | |||
*[[Cocaine]] | |||
*[[Digitalis]] | |||
*[[Digoxin]] | |||
*[[Electrolyte abnormalities]] | |||
*[[Fever]] | |||
*[[Global T-wave inversion]] | |||
*[[Hypertrophic cardiomyopathy]] | |||
*[[Hyperventilation]] | |||
*[[Hypokalemia]] | |||
*[[Intracranial hemorrhage]] | |||
{{ColBreak}} | |||
*[[Lead aVR of normal ECG]] | |||
*[[Memory T-wave phenomenon]] | |||
*[[Myocardial infarction]] | |||
*[[Myocardial ischemia]] | |||
*[[Myocarditis]] | |||
*[[Normal finding in children]] | |||
*[[Normal variant of repolarization]] | |||
*[[Persistent juvenile T-wave pattern]] | |||
*[[Pre-excitation syndrome]] | |||
*[[Pulmonary embolism]] | *[[Pulmonary embolism]] | ||
*[[Raised intracranial pressure]] | |||
*[[Restrictive cardiomyopathy]] | |||
*[[ | *[[Standing]] | ||
*[[Status epilepticus]] | |||
*[[Stress cardiomyopathy]] | |||
*[[Takotsubo cardiomyopathy]] | |||
*[[Ventricular ectopic beats]] | |||
*[[Ventricular hypertrophy with strain]] | |||
*[[Ventricular paced beats]] | |||
*[[Wellens' syndrome]] | |||
*[[WPW syndrome]] | |||
{{EndMultiCol}} | |||
==References== | ==References== |
Latest revision as of 18:24, 12 October 2012
WikiDoc Resources for T wave inversion |
Articles |
---|
Most recent articles on T wave inversion Most cited articles on T wave inversion |
Media |
Powerpoint slides on T wave inversion |
Evidence Based Medicine |
Clinical Trials |
Ongoing Trials on T wave inversion at Clinical Trials.gov Trial results on T wave inversion Clinical Trials on T wave inversion at Google
|
Guidelines / Policies / Govt |
US National Guidelines Clearinghouse on T wave inversion NICE Guidance on T wave inversion
|
Books |
News |
Commentary |
Definitions |
Patient Resources / Community |
Patient resources on T wave inversion Discussion groups on T wave inversion Patient Handouts on T wave inversion Directions to Hospitals Treating T wave inversion Risk calculators and risk factors for T wave inversion
|
Healthcare Provider Resources |
Causes & Risk Factors for T wave inversion |
Continuing Medical Education (CME) |
International |
|
Business |
Experimental / Informatics |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: negative T wave; negative T waves; inverted Ts;flipped T waves; flipped T wave; flipped Ts
Overview
T wave inversion is a non-specific electrocardiographic sign in which the T wave, an electrical signal that occurs when the heart is repolarizing or recharging itself, it is upside down instead of upright.
Classification
Primary T Wave Inversion
These changes in the T wave represent a primary abnormality in electrical repolarization (i.e. they are not due to or secondary to a change in conduction). Examples include the dig effect, myocardial ischemia or central nervous system events such as subarachnoid hemorrhage.
Secondary T Wave Inversion
The T wave may be inverted as a result of changes in the sequence of ventricualr activation such as is seen with premature ventricular contractions (PVCs), left bundle branch block, right bundle branch block (RBBB) and pre excitation syndromes like WPW.
Causes
- Arrhythmogenic RV dysplasia should be suspected in this cohort if the T wave inversion persists beyond lead V1 in a post pubertal male athlete
- Cerebrovascular accidents can cause deep widely splayed T waves referred to as cerebral T waves
- Digoxin effect or Dig effect
- Electrolyte disturbance
- Ischemic heart disease including non ST segment elevation MI or prior MI
- Left bundle branch block, it is normal for the T wave to be inverted if the QRS complex is upright
- Left ventricular hypertrophy with strain
- Myocarditis
- Persistent juvenile T-wave pattern
- Premature ventricular contraction
- Pulmonary embolism, particularly in the anterior precordium
- Restrictive cardiomyopathy
- Subarachnoid hemorrhage
- Unstable angina
- Wellens' syndrome
- Wolff-Parkinson-White syndrome (WPW)
Causes by Organ System
Causes in Alphabetical Order