Share this Article
Lin WQ, Teo SG, Poh KK
Correspondence: A/Prof Poh Kian Keong, kian_keong_poh@nuhs.edu.sg
ABSTRACT
The causes of abnormal T waves on electrocardiography are multiple and varied. Careful clinical history taking and physical examination are necessary for accurate identification of the cause of such abnormalities. Subsequent targeted specialised cardiac investigations, such as echocardiography or coronary angiography, may be of importance in the diagnosis of the underlying cardiac pathology. We present two cases of T wave inversions with markedly different aetiologies.
Keywords: ECG, hypertrophic cardiomyopathy, ischaemic heart disease, T wave abnormalities
Singapore Med J 2013; 54(11): 606-610; http://dx.doi.org/10.11622/smedj.2013218
REFERENCES
| 1. Poh KK, Teo SG, Tay EL, Yip JW. Electrocardiography Series. ECGs of structural heart disease: Part 1. Singapore Med J 2011; 52:855-8; quiz 859. | ||||
| 2. Sokolow M, Lyon TP. The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J 1949; 37:161-86. http://dx.doi.org/10.1016/0002-8703(49)90562-1 | ||||
| 3. Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P. Improved sexspecific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings. Circulation 1987; 75:565-72. http://dx.doi.org/10.1161/01.CIR.75.3.565 | ||||
| 4. Hanna EB, Glancy DL. ST-segment depression and T-wave inversion: classification, differential diagnosis, and caveats. Cleve Clin J Med 2011; 78:404-14. http://dx.doi.org/10.3949/ccjm.78a.10077 | ||||
| 5. Rautahraju PM, Surawicz B, Gettes LS, et al. AHA/ ACCF/ HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiography. J Am Coll Cardiol 2009; 53:982-91. | ||||
| 6. Prutkin JM. ECG tutorial: ST and T wave changes. In: UpToDate Inc [online]. Available at: http://www.uptodate.com/contents/ecg-tutorialst-and-t-wave-changes. Accessed October 14, 2013. | ||||
| 7. Aro AL, Anttonen O, Tikkanen JT, et al. Prevalence and prognostic significance of T-wave inversions in right precordial leads of a 12-lead electrocardiogram in the middle-aged subjects. Circulation 2012; 125:2572-7. http://dx.doi.org/10.1161/CIRCULATIONAHA.112.098681 | ||||
| 8. de Zwaan C, Bär FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J 1982; 103(4 Pt 2):730-6. http://dx.doi.org/10.1016/0002-8703(82)90480-X | ||||
| 9. Maron BJ. Hypertrophic cardiomyopathy: a systematic review. JAMA 2002; 287:1308-20. http://dx.doi.org/10.1001/jama.287.10.1308 | ||||
| 10. Prinz C, Farr M, Hering D, Horstkotte D, Faber L. The diagnosis and treatment of hypertrophic cardiomyopathy. Dtsch Arztebl Int 2011; 108:209-15. | ||||
| 11. Yamaguchi H, Ishimura T, Nishiyama S, et al. Hypertrophic nonobstructive cardiomyopathy with giant negative T waves (apical hypertrophy): ventriculographic and echocardiographic features in 30 patients. Am J Cardiol 1979; 44:401-12. http://dx.doi.org/10.1016/0002-9149(79)90388-6 | ||||
| 12. Mulvagh SL, Rakowski H, Vannan MA, et al. American Society of Echocardiography Consensus Statement on the Clinical Applications of Ultrasonic Contrast Agents in Echocardiography. J Am Soc Echocardiogr 2008; 21:1179-201. http://dx.doi.org/10.1016/j.echo.2008.09.009 | ||||