Upright T wave in V1

Subscribe to Resus

Get the latest updates on our Conferences PLUS our Webcasts and Education Newsletters. And it's FREE!

  • We respect your privacy
  • This field is for validation purposes and should be left unchanged.

Register Now:

Sorry, we couldn't find any posts. Please try a different search.

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:

  1. 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).)
  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

  1. Ischaemia: This can be single or multiple vessel disease and involves one or more of the following:
    1. Left Circumflex
    2. Right Coronary Artery
    3. Left Anterior Descending
  2. Left Ventricular Hypertrophy
  3. LBBB
  4. High Left ventricular voltage
  5. 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.


  1. 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
  2. Pinto J J et al. Tall upright T waves in the precordial leads. Circulation 1987;36(5):708-16
  3. 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

Dr Peter Kas

Emergency Physician, Educator. Key Interests: Resuscitation, Airway, Emergency Cardiology, Clinical Examination. Creator resus.com.au.


  1. Daliparty Sai Vittal on 03/09/2019 at 7:40 pm

    Nice discussion of positive T in V1

  2. mnvgrlpxe on 10/09/2021 at 1:37 pm

    Upright T wave in V1 – Resus
    mnvgrlpxe http://www.gh35eq2075tcb8411ku4pm894cqtd52zs.org/

  3. Testo X Men on 18/09/2021 at 10:44 am

    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

  4. Pure CBD Softgels Cost on 18/09/2021 at 11:03 am

    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

  5. caffemartierdelray.com on 18/09/2021 at 11:11 am

    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!

  6. Bioneo Farms CBD Review on 18/09/2021 at 11:16 am

    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

  7. Quick Keto Trim Ingredients on 18/09/2021 at 12:12 pm

    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.

    My web-site … Quick Keto Trim Ingredients

  8. Erectesto XL Male Enhancement on 18/09/2021 at 12:14 pm

    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

  9. Ambrose on 18/09/2021 at 1:05 pm

    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)

  10. A1 Keto BHB Reviews on 18/09/2021 at 1:11 pm

    You have brought up a very fantastic details, appreciate it
    for the post.

    Feel free to visit my homepage A1 Keto BHB Reviews

  11. polywebhost.com on 18/09/2021 at 1:14 pm

    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,

  12. GrownMD CBD on 18/09/2021 at 1:43 pm

    Awesome info over again. Thank you=)

    My blog post :: GrownMD CBD

  13. Keto X3 Review on 18/09/2021 at 1:46 pm

    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

  14. Grown MD CBD on 18/09/2021 at 2:51 pm

    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

  15. Renew Brite Advanced Teeth Whitening on 18/09/2021 at 3:00 pm

    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

  16. Mega Male on 18/09/2021 at 3:09 pm

    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

  17. Extreme Keto EFX Ingredients on 18/09/2021 at 4:06 pm

    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

  18. Bailey on 19/09/2021 at 11:56 pm

    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.

  19. Natisha on 20/09/2021 at 9:15 am

    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!

  20. Lilian on 20/09/2021 at 10:54 am

    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!

Leave a Comment