Canyon T Waves Seen as Narrowing of Anterolateral T-Wave Inversions in a Patient With Recurrent Chest Pain Presumed to Be Due to Anterolateral Ischemia

A 48-year-old male was admitted to the emergency department because of intermittent chest pain of 2 days duration. At the time of examination, he was pain-free. An electrocardiogram (ECG) showed biphasic T waves in leads V2 to V6. Troponin-I level was negative. During his transfer to the cardiac catheterization laboratory, he had a short episode of chest pain. His ECG was normal. Despite the unusual extension of biphasic T waves to the lateral precordial leads, the condition was recognized as Wellens’ syndrome, which typically associates biphasic or deep symmetric T wave inversion in leads V2 and V3 during pain-free periods with a critical stenosis in the proximal left anterior descending artery. The syndrome is uncommon to medical practice but should be recognized immediately in the emergency department because it represents a pre-infarction stage and carries a high risk of mortality.

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Young male with chest pain and abnormal T-waves

Emergency Care Journal ◽

10.4081/ecj.2020.8751 ◽

2020 ◽

Vol 16 (1) ◽

Author(s):

Amrithanand Velluridathil Thazhathidathil ◽

Naman Agrawal ◽

Roshan Mathew

Keyword(s):

Chest Pain ◽

Early Recognition ◽

Young Male ◽

Artery Occlusion ◽

Ecg Changes ◽

Diagnostic Challenge ◽

Rare Presentation ◽

Coronary Syndrome ◽

T Wave ◽

T Waves

Early recognition of ECG signs of acute coronary syndrome is essential for prompt treatment. But presentation with atypical ECG changes constitute a diagnostic challenge. We here report a case of 23-year-old male who presented with chest pain having atypical ECG changes with hyper-acute T waves called de Winters T wave. This is a rare presentation of patient with acute Left Anterior Descending artery occlusion. Some authors propose that de Winters pattern should be considered as “STEMI Equivalent”.

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Abstract 3265: A Comparison of Echocardiographic and Electrocardiographic Characteristics of Patients with Apical Hypertrophic Cardiomyopathy

Circulation ◽

10.1161/circ.116.suppl_16.ii_734-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Josepha Binder ◽

Brandon R Grossardt ◽

Christine Attenhofer Jost ◽

Kyle W Klarich ◽

Michael J Ackerman ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Ejection Fraction ◽

Left Ventricular ◽

Right Atrial ◽

Apical Hypertrophic Cardiomyopathy ◽

T Wave ◽

Atrial Enlargement ◽

Lv Ejection Fraction ◽

The Relationship ◽

T Waves

Background: Apical hypertrophic cardiomyopathy (apical HCM) is a less common subtype of HCM characterized by a focal thickening in the left ventricular apex. “Classic” ECG features have been described, however, apical HCM can persist for many years without detection. We investigated the relationship between ECG findings and echocardiographic morphometry in a large referral series of patients with apical HCM. Methods: We enumerated all patients diagnosed with apical HCM prior to Sept. 30, 2006 using the Mayo Clinic HCM database. We compared echocardiographic measures separately for patients with positive status for two ECG indices of left ventricular hypertrophy (LVH); the Sokolow-Lyon index and the Romhilt-Estes (RE) point-score. We also compared echocardiographic measurements in patients with and without negative T-waves in the precordial leads. Results: Apical HCM was detected in 177 patients (111 men and 68 women). Only 51% had positive Sokolow criteria and 51% had positive RE criteria. The agreement between Sokolow and RE status was high (agreement = 75.0%; kappa = 0.50; 95% CI = 0.38 – 0.62). In particular, Sokolow positive patients had increased LV ejection fraction (P = 0.02), and decreased LV end-systolic diameter (P = 0.03) compared with Sokolow negative patients. The prevalence of right atrial enlargement (47 vs. 28%; P = 0.02) and intracavity obstruction (22 vs. 8%; P = 0.01) were more common in Sokolow positive patients. Positive RE criteria was associated with a greater thickness of the basal septal and basal posterior walls (P = 0.001 and 0.02, respectively), and with a higher frequency of intracavity obstruction (21 vs. 9%; P = 0.04). Most patients (89%) exhibited at least one negative T-wave in the precordial leads; however, only 10% of patients had a negative T-wave of greater than 1.0 mV. We found that patients with an inverted T-wave larger than 0.4 mV (median) had a significantly increased LV ejection fraction (P = 0.03) compared with patients who had smaller or no negative T-waves. Conclusions: Among patients with apical HCM, nearly half do not have ECG evidence of LVH based on classic criteria and most do not have marked T-wave inversions. However, the majority did have at least a mild expression of negative T-waves.

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Physiological ECG Value for Polish Half-Bred Anglo-Arab Horses

Bulletin of the Veterinary Institute in Pulawy ◽

10.2478/v10213-012-0111-4 ◽

2012 ◽

Vol 56 (4) ◽

pp. 631-635 ◽

Cited By ~ 1

Keyword(s):

Heart Rate ◽

P Wave ◽

P Waves ◽

T Wave ◽

Duration Time ◽

Qt Intervals ◽

Electrocardiographic Examination ◽

Electrocardiographic Findings ◽

Almost All ◽

T Waves

Abstract The electrocardiographic examination was performed in 33 training horses (2-16 years of age, 11 males and 22 females). Einthoven and precordial leads (I, II, III, aVR, aVL, aVF, CV1, CV2, CV4) were used. The ECG was performed in resting horses and immediately after exercise (10 min walk, 15 min trot, 10 min canter) using a portable Schiller AT-1 3-channel electrocardiograph, with a paper speed of 25 mm sec-1 and a sensitivity of 10 mm.mV-1. The heart rate, wave amplitudes, and duration time were estimated manually. All horses presented a significant increase in heart rate after exercise (rest 43.83 ±10.33 vs. exercise 73.2 ±14.8). QT intervals were significantly shortened in most of the leads. In resting horses, all P waves in the lead I were positive and almost all II, III and CV4 leads were positive. Simple negative P wave dominated in aVR and only simple negative T wave was found in the leads I. The biphasic shape was observed. After exercise, the amplitude of P and T waves rose, however, clear changes were not observed in wave polarisation and form. In the absence of specific racial characteristics of the electrocardiogram in the Polish Anglo- Arabians, electrocardiographic findings can be interpreted according to ECG standards adopted for horses.

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Left ventricular dysfunction causing ischemia in patients with patent coronary arteries

Perfusion ◽

10.1177/0267659117727826 ◽

2017 ◽

Vol 33 (2) ◽

pp. 115-122

Author(s):

Thach Nguyen ◽

Hoang Do ◽

Tri Pham ◽

Loc T Vu ◽

Marco Zuin ◽

...

Keyword(s):

Chest Pain ◽

Coronary Artery ◽

Diastolic Pressure ◽

Left Ventricular ◽

T Wave ◽

St Depression ◽

Wave Inversion ◽

Group A ◽

Group B ◽

New Onset

Background: New onset of heart failure (HF) is an indication for the assessment of coronary artery disease. The aim of this study was to clarify the mechanistic causes of new onset HF associated with ischemic electrocardiograph (EKG) changes and chest pain in patients with patent or minimally diseased coronary arteries. Methods: Twenty consecutive patients (Group A) were retrospectively reviewed if they had an history of new onset of HF, chest pain, electrocardiographic changes indicating ischemia (ST depression or T wave inversion in at least two consecutive leads and a negative coronary angiogram [CA]) and did not require percutaneous coronary intervention or coronary artery bypass grafting. A 1:1 matched cohort (Group B) was adopted to validate the results. Results: All patients had a negative CA. The majority of subjects in Group A had a higher left ventricular end diastolic pressure (LVEDP) when compared to the control group (p<0.05). Similarly, the aortic diastolic (AOD) pressure was lower in Group A than in Group B (p<0.05). In patients with elevated LVEDP and low AOD, with a coronary perfusion pressure (CPP) <20 mmHg, deep T wave inversion in two consecutive leads were more frequently observed. When the CPP was between 20-30 mmHg, a mild ST depression were more frequently recorded (p<0.05). Conversely, when the CPP was >30 mmHg, only mild non-specific ST-T changes or normal EKG were observed. Conclusions: In patients with HF and EKG changes suggestive of ischemia in at least two consecutive leads, a lower AOD could aggravate ischemia in patients with elevated left ventricular end diastolic pressure.

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Atypical T Waves in a Man With Atypical Chest Pain

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2021.05.019 ◽

2021 ◽

Vol 78 (4) ◽

pp. 535-537

Author(s):

Po-Chun Chuang ◽

Kuo-Chen Huang ◽

Ying-Chen Hsu ◽

Xin-Hong Lin

Keyword(s):

Chest Pain ◽

Atypical Chest Pain ◽

T Waves

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Differences in the diagnostic value of various criteria of negative T waves for hypertrophic cardiomyopathy based on a molecular genetic diagnosis

Clinical Science ◽

10.1042/cs20060293 ◽

2007 ◽

Vol 112 (11) ◽

pp. 577-582 ◽

Cited By ~ 12

Author(s):

Tetsuo Konno ◽

Noboru Fujino ◽

Kenshi Hayashi ◽

Katsuharu Uchiyama ◽

Eiichi Masuta ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Molecular Genetic ◽

Genetic Diagnosis ◽

Diagnostic Value ◽

Left Ventricular ◽

Lower Sensitivity ◽

T Wave ◽

Accurate Definition ◽

Definition Of ◽

T Waves

Differences in the diagnostic value of a variety of definitions of negative T waves for HCM (hypertrophic cardiomyopathy) have not yet been clarified, resulting in a number of definitions being applied in previous studies. The aim of the present study was to determine the most accurate diagnostic definition of negative T waves for HCM in genotyped populations. Electrocardiographic and echocardiographic findings were analysed in 161 genotyped subjects (97 carriers and 64 non-carriers). We applied three different criteria that have been used in previous studies: Criterion 1, negative T wave >10 mm in depth in any leads; Criterion 2, negative T wave >3 mm in depth in at least two leads; and Criterion 3, negative T wave >1 mm in depth in at least two leads. Of the three criteria, Criterion 3 had the highest sensitivity (43% compared with 5 and 26% in Criterion 1 and Criterion 2 respectively; P<0.0001) and retained a specificity of 95%, resulting in the highest accuracy. In comparison with abnormal Q waves, negative T waves for Criterion 3 had a lower sensitivity in detecting carriers without LVH (left ventricular hypertrophy) (12.9% for negative T waves compared with 22.6% for abnormal Q waves). On the other hand, in detecting carriers with LVH, the sensitivity of negative T waves increased in a stepwise direction with the increasing extent of LVH (P<0.001), whereas there was less association between the sensitivity of abnormal Q waves and the extent of LVH. In conclusion, Criterion 3 for negative T waves may be the most accurate definition of HCM based on genetic diagnoses. Negative T waves may show different diagnostic value according to the different criteria and phenotypes in genotyped populations with HCM.

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Momentary giant T‐waves hint the genesis of the electrocardiographic T‐wave in human

Journal of Arrhythmia ◽

10.1002/joa3.12105 ◽

2018 ◽

Vol 34 (6) ◽

pp. 640-642 ◽

Cited By ~ 1

Author(s):

Tomiya Yasumasu

Keyword(s):

T Wave ◽

T Waves

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Seismic T-Wave Observations at Dense Seismic Networks

Seismological Research Letters ◽

10.1785/0220200208 ◽

2020 ◽

Vol 91 (6) ◽

pp. 3444-3453

Author(s):

Catherine D. de Groot-Hedlin

Keyword(s):

Wave Propagation ◽

West Coast ◽

East Coast ◽

Seismic Energy ◽

Polarization Analysis ◽

The West ◽

P Waves ◽

Transverse Waves ◽

T Wave ◽

T Waves

Abstract Seismic T waves, which result from transformation of hydroacoustic to seismic energy at coastlines, were investigated for two strong earthquakes. A 2014 Caribbean event generated seismic T waves that were detected at over 250 seismometers along the east coast of the U.S., primarily at seismic stations operated by the USArray Transportable Array. A 2006 Hawaiian event generated seismic T waves observed at over 100 seismometers along the west coast. Seismic T-wave propagation was treated as locally 2D where the incoming hydroacoustic wavefronts were nearly parallel to the coastlines. Along the east coast, seismic T-wave propagation velocities were consistent with surface waves and a polarization analysis indicated that they were transverse waves, supporting their interpretation as Love waves. They were observed at inland distances up to 1134 km from the east coast. Along the west coast, the propagation velocity was over 5 km/s and a polarization analysis confirmed that the seismic T waves propagated as seismic P waves. Differences between the modes of propagation along the east and west coasts are attributed to differences in the slope and thickness of the sediment coverage at the continental slopes where hydroacoustic to seismic conversion takes place.

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Prolongation of Electrocardiographic T Wave Parameters Recorded during the Head-Up Tilt Table Test as Independent Markers of Syncope Severity in Children

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17186441 ◽

2020 ◽

Vol 17 (18) ◽

pp. 6441

Author(s):

Grażyna Markiewicz-Łoskot ◽

Ewelina Kolarczyk ◽

Bogusław Mazurek ◽

Marianna Łoskot ◽

Lesław Szydłowski

Keyword(s):

Vasovagal Syncope ◽

The Other ◽

Control Group ◽

Tilt Table Test ◽

Tilt Table ◽

T Wave ◽

Good Discriminator ◽

Wave Morphology ◽

Head Up Tilt ◽

T Waves

The head-up tilt table test (HUTT) with the upright phase is used to help determine an imbalance of the sympathetic nervous system that is related to abnormal electrocardiographic repolarization in children with vasovagal syncope (VVS) and also in patients with the long QT syndrome (LQTS). The study attempted to evaluate T wave morphology and QT and TpTe (Tpeak–Tend) intervals recorded in ECG during the HUTT for a more accurate diagnosis of children with VVS. The group investigated 70 children with a negative HUTT result: 40 patients with VVS and 30 healthy volunteers without syncope. The RR interval as well as TpTe, and QTc intervals were measured in lead V5 of electrocardiogram (ECG) on admission to the hospital and during three phases of the HUTT. In syncopal children, which included 23 children with bifid or flat T waves and 17 patients with normal T waves in the upright phase, the QTc and TpTe were longer (p < 0.001) compared to the other test phases and longer (p < 0.001) than in the control group, respectively, with the risk of arrhythmias. Only in the control group, the TpTe was shorter (p < 0.001) in the upright phase than in the other tilt phases. The TpTe in the upright phase (>70 ms) was a good discriminator, and was better than the QTc (>427 ms). Prolongation of electrocardiographic TpTe and QT intervals, in addition to the (abnormal T wave morphology recorded during the HUTT, are helpful for identifying VVS children more predisposed to ventricular arrhythmias with a latent risk of LQTS. Further studies are required to assess the value of these repolarization parameters in clinical practice.

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