9 morphology of t
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12-Lead Electrocardiographya comprehensive course
Adam Thompson, EMT-P, A.S.
Morphologi
es
(The “T”)
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T Wave
• Should not be symmetrical.
• Should be upright in every lead but aVR.
• Height should correlate with QRS.
• Should have a dull peak.
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Symmetrical T-Wave
AsymmetricalNormal
SymmetricalAbnormal
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Hyperkalemia
• Hyperkalemia = High Potassium Level– Peaked T-Waves
• May mimic an acute MI
– Sine Waves• Sign of lethally high potassium level
Sine Wave
Peaked T-Wave
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Hyperkalemia
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Hyperkalemia
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Hyperkalemia
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T-Wave Discordance
• Discordance means opposite.– T-Wave discordance means that the T-Wave
is deflected in the opposite direction as the terminal (last) wave of the QRS.
– T-Wave discordance is normal in every lead with Left or Right BBBs.
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T-Wave Discordance
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Digitalis Effect
• Shortened QT interval• Characteristic down-sloping ST depression• Dysrhythmias
– ventricular / atrial premature beats– paroxysmal atrial tachycardia with variable AV block– ventricular tachycardia and fibrillation– many others
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QT-Interval
Normal QTc
< 460 ms
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QT-Interval
Measures the time from when depolarization starts to the end of repolarization.
QTc = RR
QT
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QT-Interval
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Long QT Syndrome
• QTc > 460ms– Congenital
• Major contributor to sudden unexplained death in children and young adults.
– Drug induced• Caused by many arrhythmia medications
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Long QT Syndrome
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U-Wave
• Usually not visible.
• Should not be prominent.
• Should never be bigger than T-wave
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Osborn Waves
• Sometimes called “J-Waves”• Indicates HYPOTHERMIA• May be associated with bradycardia• Extra wave at the J-Point of the QRS-
complex.
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Osborn Waves
Osborn Waves
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END
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