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Ischemic T waves rise and then fall below the cardiac resting membrane potential; Hypokalemic T waves fall and then rise above the cardiac resting membrane potential; Wellens' Syndrome is a pattern of biphasic T waves in V2–3. It is generally present in patients with ischemic chest pain. Type 1: T-waves are symmetrically and deeply inverted
Originally thought of as two separate types, A and B, it is now considered an evolving wave form, initially of biphasic T wave inversions and later becoming symmetrical, often deep (>2 mm), T wave inversions in the anterior precordial leads. [1]
Type 1 has a coved type ST elevation with at least 2 mm (0.2 mV) J-point elevation and a gradually descending ST segment followed by a negative T-wave. [35] Type 2 has a saddle-back pattern with at least 2 mm J-point elevation and at least 0.5 mm elevation of the terminal ST segment with a positive or biphasic T-wave. [35]
The earliest sign is hyperacute T waves, peaked T waves due to local hyperkalemia in ischemic myocardium. This then progresses over a period of minutes to elevations of the ST segment by at least 1 mm. Over a period of hours, a pathologic Q wave may appear and the T wave will invert. Over a period of days the ST elevation will resolve.
any of biphasic (–/+), positive or negative in lead aVL; positive in all chest leads, except for V1 which may be biphasic (+/–) [2] If the P waves do not meet these criteria, they must be originating from an abnormal site elsewhere in the atria and not from the sinus node; the ECG cannot, therefore, be classed as showing a sinus rhythm. [2]
A mnemonic can be used for some causes of ST depression, namely DEPRESSED ST: [citation needed]. D - Drooping valve (mitral valve prolapse) E - Enlargement of the left ventricle P - Potassium loss R - Reciprocal ST depression (e.g. inferior wall MI) E - Encephalon hemorrhage S - Subendocardial infarct S - Subendocardial ischemia E - Embolism (pulmonary) D - Dilated cardiomyopathy S - Shock T ...
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Diagnosis is based on an ECG showing ST-segment depression at the J-point of 1 to 3 mm in leads V1 to V6, with tall and symmetrical T waves. [1] The ST-segment is upsloping and there is also often ST-segment elevation of 0.5 to 2 mm in lead aVR. [1] [2] The QRS complex is either normal or slightly wide. [1]