The T Wave Conundrum

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.T_V1 < T_V6This is normal.In the next ECG, the T is upright in V1.

However T_V1 < T_V6Hence 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. T_V1 > T_V6

Although this may be abnormal, most people would wisely call this “within normal limits” when reporting.Here is an example of T_V1 > T_V6

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.

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Harry Mond