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)
●Electrolyte abnormalitiesTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- 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