ECG tutorial: ST and T wave changes
- Jordan M Prutkin, MD, MHS, FHRS
Jordan M Prutkin, MD, MHS, FHRS
- Associate Professor of Medicine, Division of Cardiology, Electrophysiology Section
- University of Washington
ST and T wave changes may represent cardiac pathology or be a normal variant. Interpretation of the findings, therefore, depends on the clinical context and presence of similar findings on prior electrocardiograms.
NONSPECIFIC ST-T WAVE CHANGES
Nonspecific ST-T wave changes are very common and may be seen in any lead of the electrocardiogram. The changes may be seen in all or most of the leads (diffuse changes), or they may be present contiguous leads, such as the inferior, lateral, or anterior leads.
The types of abnormalities are varied and include subtle straightening of the ST segment, actual ST segment depression or elevation, flattening of the T wave, biphasic T waves, or T wave inversion (waveform 1). In the absence of a clinical history or symptoms, T wave abnormalities and flattened and depressed ST segment changes are nonspecific. Causes of these changes include:
●Functional and physiologic variants (eg, post-prandial)
- Aro AL, Anttonen O, Tikkanen JT, et al. Prevalence and prognostic significance of T-wave inversions in right precordial leads of a 12-lead electrocardiogram in the middle-aged subjects. Circulation 2012; 125:2572.
- Papadakis M, Carre F, Kervio G, et al. The prevalence, distribution, and clinical outcomes of electrocardiographic repolarization patterns in male athletes of African/Afro-Caribbean origin. Eur Heart J 2011; 32:2304.
- Sheikh N, Papadakis M, Ghani S, et al. Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes. Circulation 2014; 129:1637.
- Bogossian H, Frommeyer G, Ninios I, et al. New formula for evaluation of the QT interval in patients with left bundle branch block. Heart Rhythm 2014; 11:2273.
- Antzelevitch C, Pollevick GD, Cordeiro JM, et al. Loss-of-function mutations in the cardiac calcium channel underlie a new clinical entity characterized by ST-segment elevation, short QT intervals, and sudden cardiac death. Circulation 2007; 115:442.
- NONSPECIFIC ST-T WAVE CHANGES
- Persistent juvenile T wave pattern
- Black/African athlete T wave variant
- ST-T WAVE CHANGES ASSOCIATED WITH SPECIFIC DISEASE STATES
- Myocardial ischemia, injury, and infarction
- Left ventricular hypertrophy
- Right ventricular hypertrophy
- Intraventricular conduction delays
- Persistent ST elevation compatible with an aneurysm
- Prolonged Q-T interval
- Short QT interval
- Tall T waves
- Prominent U waves