Assoc Prof Harry Mond
December 2, 2024
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We often see an ECG report stating, “Non-specific T wave changes” or “Non-specific T wave flattening” and wonder what it means.At the end of this presentation you will still be asking that question, but at least you will know how to correctly diagnose it. There are different types of T wave changes in different leads and we easily recognise left ventricular hypertrophy and myocardial ischaemia. This presentation will be limited to the subtle T wave changes from V1 to V6.This ECG is obviously normal:
Look at the height of the T wave from V1 to V6.TV1 < TV6This is normal.In the next ECG, the T is upright in V1.
However TV1 < TV6Hence this is normal.In the next example, the T waves in V1 or V6 are almost the same. We would all call this normal.
What about when the T wave in V1 exceeds the T wave in V6? i.e. TV1 > TV6
Although this may be abnormal, most people would wisely call this “within normal limits” when reporting.Here is an example of TV1 > TV6
This is what we call “non-specific T wave abnormality”. My mentor Henry “Barney” Marriott would call this a “Primary T wave abnormality”. No I don’t know what that means, and I am sure he didn’t know either. It’s what catches the eye.
Harry Mond
October 29, 2026
As its name implies, AVNRT is a reentrant junctional or supraventricular tachyarrhythmia which involves the fast and slow pathways within the AV node creating a self-perpetuating circus movement. It can be divided into typical (slow-fast) or atypical (fast-slow) as well as several rarer forms related to more than one slow or fast pathway with similar electrophysiological properties. On the ECG, they can be identified and differentiated by the positioning of the P wave in relation to the QRS complex, which in turn is related to the direction of the re-entrant AV nodal circuit. However, in about 60% of cases, the P wave is buried in the QRS/T and cannot be identified on the surface ECG.
October 16, 2026
Retrograde conduction is defined as conduction from an ectopic site to the atrium via the AV node or accessory pathway and referred to as VA conduction. II results in a P wave configuration which differs from an anterograde P wave, and in most ECG leads is inverted. The site from where the impulse originates can be the AV node, Bundle of His, distal conducting system or the body of the ventricles including ventricular pacing. On the ECG, the QRS complex usually precedes the inverted retrograde P wave but on occasion may follow it.
October 26, 2026
In 1970, I commenced work as a “novice” cardiologist at The Royal Melbourne Hospital. Training at that time was learning how to recognise the diastolic murmur of mitral stenosis and making sure the ECG and chest x-rays were the correct way up. As this was prior to coronary artery surgery, stenting and echocardiography, the ECG was a highly respected tool for the diagnosis of many conditions. I was fortunate to befriend a number of the gurus of ECG interpretation who taught me to look into the soul of an ECG. Today, even though the ECG is the first investigation performed by a cardiologist, the art of ECG interpretation has been lost because we depend on the new tools for cardiac diagnosis.
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