February Tip of The Month - 12 lead interpretation Week 3

Weekly ECG Challenge – Week 3

Focus of the Week: The T Wave

This week, our focus is on the T wave, an essential indicator of ventricular repolarization and a key feature in identifying various cardiac and metabolic conditions.

Key Characteristics of T Waves:

Normally upright, except in aVR, V1, and sometimes lead III.
Typical morphology: Gradual ascent with a sharp, rapid descent.
Proportional height: Should be less than 5 mm in limb leads and less than 10 mm in precordial leads.

Common Causes of Tall T Waves:

1. Normal Variants & Benign Causes:

Early repolarization (BER) – A normal variant, often seen in young, healthy individuals.

2. Secondary to Abnormal Depolarization:

Left Bundle Branch Block (LBBB) – Characterized by deep/wide anterior S waves, followed by ST elevation and tall T waves.
Left Ventricular Hypertrophy (LVH) – Notable for deep/narrow anterior S waves, also followed by ST elevation and tall T waves.

3. Primary Repolarization Abnormalities:

Hyperkalemia:
- Produces "peaked T waves" that are diffuse, narrow-based, and sharply pointed.
- Often associated with other signs of hyperkalemia, including bradycardia, junctional rhythms, prolonged PR intervals, and widened QRS complexes.
Hyperacute T Waves (HATW):
- Often seen in acute coronary occlusion (MI).
- Appear regional (localized to the affected territory), with broad bases, rounded peaks, and disproportionate height relative to the QRS.
- Frequently accompanied by other signs of acute ischemia, such as loss of R wave progression, new Q waves, ST elevation, and reciprocal ST depression.

Your Task:

Below, you will find ECG examples from patients presenting with acute chest pain. Review each ECG carefully and attempt to categorize them based on the patterns described above.

Consider: