T-waves in ischemia: hyperacute, inverted (negative), Wellen’s sign & de Winter’s sign

T-waves in ischemia: hyperacute, inverted (negative), Wellen’s sign & de Winter’s sign

T-wave changes in acute myocardial infarction & ischemia A thorough discussion regarding the  physiology of the T-wave  was previously provided. Only aspects relevant to ischemia will be discussed here. The T-wave is notoriously difficult to judge, which is why a rather comprehensive discussion is warranted. The normal T-wave will be described first. Then, ischemic T-wave changes –  i.e hyperacute T-waves, inverted T-waves, flat T-waves, Wellen’s syndrome and de Winter’s syndrome  – will be discussed in detail. The normal T-wave The normal T-wave is concordant with the QRS complex, meaning that it has the same direction as the net direction of the QRS complex. A net positive QRS complex should be followed by a net positive T-wave ( refer to the previous discussion on concordance/discordance  and  Figure 1 ). If the T-wave and the QRS complex heads in the opposite directions, the T-wave is said to be discordant which is abnormal. Because most  ECG leads  have net positive QRS complexes (during …

Continue reading...