Tuesday, May 26, 2015

New 40 minute lecture on T-wave Inversion



T-wave Inversion

I just found one mistake at minutes 7:00 to 7:30: 

The QRS axis is 90 degrees and the T-wave axis minus 30, for a QRST angle of 120 degrees.


18 comments:

  1. Fantastic lecture. Thank you. Please record more.

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    1. Jim,
      Thanks! Please spread the word.
      You can see other lectures posted down the sidebar.
      Steve

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  2. thanks dr Smith, very interesting and practic information

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  3. I think that QRS axis is +60 and T wave axis is -30 so the difference is 90 ( min 7:00 to 7:30) ? But what is normal range for Axis difference between QRS and T wave and its significance ?

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    1. Normal is not easily defined, but as the difference gets larger, the risk gets proportionally larger. > 100 definitely abnormal. My attention is caught if the angle is greater than 60 degrees, but this is not definitely abnormal.

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    2. But i know that If QRS-T angle >100 ,It's suspicious for secondary abnormality rather than primary as LVH ,and There is a big chance it’s not a STEMI ?
      So when to consider QRS/T angle abnormal if more than 100 ?

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  4. No good data. Large QRST angle does not imply STEMI. greater than 100 I would always consider abnormal. What it indicates depends on many factors.

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  5. I was waiting for this kind of lecture since long..THNX U sooo much...My question is in majority of females with or without chest pain we see so many repolarisation abnormalities so calles T wave changes..why so? It unnecessarily ends up investigating further including angio..as they complaints also some kind of non specific chest pain many times...Sir please opine..thanks once again

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  6. Only because the usual teaching is that T-wave inversion is ischemia and dangerous, when in fact most is benign. But it is not simple to tell the difference. Takes lots of study and experience.

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  7. hello
    8:53 28/F with anxiery and CP... any comments on lead 1 T wave in both ECGs??

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    1. I think they are within normal limits

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  8. 40:08.... which wall is involved?????????

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  9. Hi Dr.med Smith,
    As I am about to complete my first year of residency (cardiology) I discussed T wave inversions and Wellens Syndrome with my fellow colleagues.
    One of my colleague is just doing a six month rotation in our Cardiology department and asked an intersting questions.
    With a patient with Wellens Syndrome, now pain free, after 6h from the first pain episode is it possibile that the high sensible troponins stay negative?
    In that case (negative high sensisble troponins) should the patients be still sent to the cath lab or sent home and undergo an elective II level imaging test (RM/ TC)?
    My opinion on the latter is that with a pathological ECG and no clear cause (unseen/unknown wellens ECG pattern) patient should stay hospitalized.
    I'm interested in what you think about these two questions.

    Thank you for your help and congratulations on your excellent blog.

    Dr.med Beltrani Vittorio
    Cardiocentro Ticino
    Swtizterland

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    1. Beltrani,
      There are many false positive Wellens' (search this blog for PseudoWellens). A lot depends on what you consider "negative" for hs cTnI. Below 99% only? 2 values that are below but have a delta? Or two values that are below the LoD? all very different. Also, what if the T-wave inversion resolves? Such dynamic T-wave inversion is NOT Wellens' but is unstable angina and will often have negative troponins. If it is Wellens', it must evolve (see this: http://hqmeded-ecg.blogspot.com/2011/03/classic-evolution-of-wellens-t-waves.html ). If no evolution, then not Wellens' and negative trops are true negative. I would say if both below LoD, then definitely not Wellens'. If both below 99% and no delta, then almost certainly not Wellens'. But if either is above 99%, or if both below 99% but with a significant delta, it certainly may be Wellens'.
      Steve Smith

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    2. Thank you for your precise and enlightening answer.
      Best Regards,
      Dr.med Beltrani

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