A 65 year old woman presents with a 20 minute episode of chest pain. Her ECG is shown below. Are there any concerning features for ischaemia?
Source: The west journal of EM 18(4):601-606 · June 2017(1)
Significance of an upright T wave in V1
Normally the T wave is inverted or flat in lead V1. An upright T wave in V1 may be considered a normal variant. However assuming that there is no ventricular hypertrophy or LBBB, a large, upright T wave in V1 may be abnormal if:
- The T wave in V1 is taller than the T wave in V6. (This is referred to as a loss in precordial T wave balance(2).)
- The upright T wave in V1 is new.
Patients with upright T waves in V1 are considered to be 4 times more likely to have significant coronary artery disease than those without(3).
Causes of upright T waves in V1
- Ischaemia: This can be single or multiple vessel disease and involves one or more of the following:
- Left Circumflex
- Right Coronary Artery
- Left Anterior Descending
- Left Ventricular Hypertrophy
- LBBB
- High Left ventricular voltage
- Lead misplacement
Keep on the lookout for T wave changes in the precordial leads. This is one of those subtle changes to be aware of.
References:
- Tewelde S et al. Pitfalls in Electrocardiographic Diagnosis of Acute Coronary Syndrome in Low-Risk Chest Pain. The Western Journal of Emergency Medicine 18(4):601-606 · June 2017
- Pinto J J et al. Tall upright T waves in the precordial leads. Circulation 1987;36(5):708-16
- Manno B.V et al. Significance of the upright T wave in precordial lead V1in adults with coronary artery disease. JACC Volume 1, Issue 5, May 1983
Peter Kas
39 Comments
Leave a Comment
Popular Posts
Paediatric Pearls
I've given a talk on Paediatric Pearls in the past. I recently revived the talk for my residents, so thought...
Treating the Hypoxic COVID-19 Patient: Can low flow systems be improved?
Hi Everyone I hope you're holding up out there. As we prepare for the onslaught that may come our way,...
Cardiogenic Shock: Which Vasopressor to use
In the patient who presents with cariogenic shock, the cath lab and a stent or a CABG is probably the...
The U wave and the ECG: Don’t miss this
The U wave is an often ignored deflection on the ECG. It is usually < 1mm, upright and has the...
5 Things you Must do when Patients Present with Syncope
Patients who present to the emergency department following a syncopal episode can be a diagnostic challenge to us. There are...
11 Things to Maximise Adult Cardiac Resuscitation
INTRODUCTION I was recently speaking with a colleague, about a recently published paper on ‘ideal’ compressions and depth combinations in...
Head injury and blood thinners-When to Scan
Head injury in the anticoagulated patient can be a challenge. Below is the approach I use. I then read a...
The 6 Human Needs
As part of a talk on ‘Dealing with Difficult People’, I gave at EMCORE Hong Kong this year, I spoke...
Nice discussion of positive T in V1
Upright T wave in V1 – Resus
[url=http://www.gh35eq2075tcb8411ku4pm894cqtd52zs.org/]umnvgrlpxe[/url]
amnvgrlpxe
mnvgrlpxe http://www.gh35eq2075tcb8411ku4pm894cqtd52zs.org/
Wow! Thank you! I always wanted to write on my website something
like that. Can I implement a portion of your post to my blog?
My web site: Testo X Men
I like the helpful information you provide in your articles.
I will bookmark your weblog and check again here regularly.
I’m quite sure I will learn a lot of new stuff right here!
Best of luck for the next!
Here is my web blog: Pure CBD Softgels Cost
It is perfect time to make some plans for the long run and it
is time to be happy. I’ve learn this post and
if I may just I desire to recommend you few interesting things or
tips. Maybe you can write next articles regarding this
article. I desire to read even more things approximately it!
I seriously love your website.. Pleasant colors & theme. Did you
make this amazing site yourself? Please reply back as I?m wanting to create my own site and would like
to find out where you got this from or what the theme is called.
Many thanks!
Also visit my blog post: Bioneo Farms CBD Review
Hi there, just became aware of your blog through Google,
and found that it’s truly informative. I am gonna watch
out for brussels. I?ll be grateful if you continue this in future.
Lots of people will be benefited from your writing.
Cheers!
My web-site … Quick Keto Trim Ingredients
Very good website you have here but I was wanting to know if you
knew of any community forums that cover the same topics discussed in this article?
I’d really like to be a part of group where I can get responses from other knowledgeable people that share
the same interest. If you have any recommendations, please let
me know. Appreciate it!
Feel free to surf to my blog post; Erectesto XL Male Enhancement
Fantastic goods from you, man. I’ve understand your stuff
previous to and you are just too great. I really like
what you’ve acquired here, really like what you’re
stating and the way in which you say it. You make it enjoyable
and you still take care of to keep it wise. I can not wait to read far more from you.
This is really a terrific web site.
my website – Max Melt Keto Pills (Ambrose)
You have brought up a very fantastic details, appreciate it
for the post.
Feel free to visit my homepage A1 Keto BHB Reviews
Hi! This post could not be written any better! Reading through this post reminds me
of my good old room mate! He always kept talking about this.
I will forward this page to him. Fairly certain he will have
a good read. Thank you for sharing!
My website: UltraXTend, polywebhost.com,
Awesome info over again. Thank you=)
My blog post :: GrownMD CBD
This web site certainly has all the information and facts
I wanted about this subject and didn?t know who to ask.
Check out my page – Keto X3 Review
Aw, this was a really good post. Taking the time and actual effort to produce a very good article…
but what can I say… I hesitate a lot and never seem to get nearly anything done.
my page: Grown MD CBD
I am glad to be a visitant of this arrant weblog, thank
you for this rare information!
Also visit my blog post :: Renew Brite Advanced Teeth Whitening
An impressive share! I’ve just forwarded this onto a coworker who had been conducting a little research on this.
And he in fact bought me lunch because I discovered it for him…
lol. So let me reword this…. Thank YOU for the meal!!
But yeah, thanx for spending some time to discuss this issue here on your internet site.
Here is my webpage – Mega Male
It’s remarkable to pay a visit this website and
reading the views of all friends regarding this paragraph, while I am also keen of getting experience.
My web blog Extreme Keto EFX Ingredients
Pretty section of content. I just stumbled upon your site and in accession capital to assert that I get
actually enjoyed account your blog posts. Anyway I will be subscribing
to your augment and even I achievement you access consistently fast.
Wow, fantastic weblog format! How long have you ever
been blogging for? you made blogging look easy.
The total look of your web site is wonderful, as smartly as the content!
My programmer is trying to convince me to move to .net from PHP.
I have always disliked the idea because of the costs.
But he’s tryiong none the less. I’ve been using WordPress on a
number of websites for about a year and am concerned about switching to another platform.
I have heard very good things about blogengine.net.
Is there a way I can transfer all my wordpress posts into it?
Any help would be really appreciated!
ブランドSaintLaurentサンローラン財布コピー代引き
Environmental Soft Pvc Raw Material
Diesel Generators
ブランドコピーFendiフェンディN級品
curve hem tshirt
Breitlingブライトリング時計コピー
Double Concave Glass Lens
Chanelシャネルネックレス販売店
ブランドコピー代引き
Boardroom Chairs
Caseless Door Jambs
SalvatoreFerragamoサルヴァトーレフェラガモベルトスーパーコピー
ブランドLouisVuittonルイヴィトンベルトコピー代引き
China Eco Friendly Menstrual Pads
BMW e90 shift knob
SaintLaurentサンローラン財布スーパーコピー
Hermesエルメスバッグコピー
Oil Gauge Factory
Private Label Candles
Tiffanyティファニーブレスレットスーパーコピー
Neck Tube Bandana
ブランドPradaプラダ財布コピーN級品
FLEECE Jacket
Bvlgariブルガリコピー激安
Chopped carbon fiber
ブランドコピー専門店
Stainless Steel Dual Plate Check Valve
ブランドバッグコピー
Plastic Grade HPMC Powder
Custom Graduation Shirts
ブランドバッグコピー
PTFE Sharpe
Large Corner Garden Furniture
ブランドコピー専門店
Permanent Adhesive Vinyl
30HP 700F 22KW Crusher
ブランドコピー代引き
Sleeve Anchor
13 Gallon Compostable Bags
ブランドコピー専門店
Plastic Floor Wall Tile
ブランドコピー専門店
Lamp Housing Mold