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T wave is considered flat when the wave varies from -1.0 mm to + 1.0 mm in height. Hypokalemia or digitalis therapy can cause flattened T wave with a prominent U wave. As hypokalemia progressively worsens, the T wave becomes more flattened while the U wave becomes more prominent, with progressively deeper ST segment depression.
R wave in most cases will be unaltered. In two weeks after pericarditis, there will be upward concave ST elevation, positive T wave, and PR depression. After several more weeks, PR and ST segments normalised with flattened T wave. At last, there will be T wave inversion which will take weeks or months to vanish. [1]
Flat, downsloping, or depressed ST segments may indicate coronary ischemia. ST elevation may indicate transmural myocardial infarction. An elevation of >1mm and longer than 80 milliseconds following the J-point. This measure has a false positive rate of 15-20% (which is slightly higher in women than men) and a false negative rate of 20–30%. [1]
Hypokalemia leads to characteristic ECG changes (PR prolongation, ST-segment and T-wave depression, U-wave formation). [4] The earliest ECG findings, associated with hypokalemia, are decreased T wave height. Then, ST depressions and T inversions appear as serum potassium levels reduce further.
Non Q-wave myocardial infarction [3] Reciprocal changes in acute Q-wave myocardial infarction (e.g., ST depression in leads I & aVL with acute inferior myocardial infarction) [3] ST segment depression and T-wave changes may be seen in patients with unstable angina; Depressed but upsloping ST segment generally rules out ischemia as a cause.
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