Pearls of Knowledge: Flipped T Waves
Thursday, February 13, 2025
12-Lead ECG Interpretation: Flipped T Waves
Pearls of Knowledge © BrainyNurses.com
A lot of information can be gleaned from a 12-Lead ECG and using systematic steps will help to identify all the components. Considering the patient’s history and clinical presentation can provide some helpful clues as to what to look for, especially if you are more of a novice in 12-Lead interpretation. When a patient is having chest pain, it is beneficial to compare the 12-Lead to a previous one. The focus for this Pearls of Knowledge is to look for changes indicating evidence of ischemia, injury, or infarction in V1-V6.
History and Clinical Correlation
84-year-old female with a history of hypertension and on beta blockers was admitted two days ago with pneumonia. She calls out complaining of chest pain. 12-Lead ECG is obtained and compared with the tracing done on admission.
12-Lead Comparison
Steps when chest pain is present.
• Identify the rhythm.
• Look for signs of an acute MI (ST segment elevation of 1 mm or more).
• Look for signs of ischemia (ST segment depression and symmetrically inverted T waves).
• Look for signs of myocardial necrosis (Q wave more than 1/3 the height of the R wave).
Interpretation
On Admission:
Sinus rhythm, 75 BPM.
ST segment elevation of ≥ 1 mm is seen in V4-V5. There is concern for anterolateral current of injury or early repolarization due to the shape of the elevation.
The T waves are upright throughout.
With Chest Pain:
Sinus bradycardia, 50 BPM.
No ST segment elevation is noted. No pathological Q waves are present.
There are deep, symmetrically inverted T waves which are present in V2-V5. V3 and V4 are anterior leads. V2 is a septal lead. V5 is a lateral lead.
Clinical Significance
The 12-Lead ECG changes with chest pain in this patient indicate what is known as Wellen’s syndrome. This involves a critical stenosis of the left anterior descending artery which supplies the anterior wall of the heart. If not recognized and treated aggressively, it has a mortality of 80% due to significant left ventricular dysfunction.
12-Lead ECG changes seen in Wellen’s syndrome.
• Minimal ST segment elevation of < 1 mm.
• Absence of Q waves.
• Deep, symmetrical T wave inversion in the precordial leads.
• Changes are typically seen in V1-V4 but may involve V5-V6.
Summary
A systematic approach to 12-Lead ECG interpretation is essential in detecting changes and applying them to the clinical setting. Changes occur with numerous conditions including acute coronary syndrome and many others.
To enhance care provided for cardiac patients, check out Clinical Application and Interpretation of the 12-Lead ECG. It is on-line, on-demand, with voice-over-power-point, and a comprehensive review to use at the bedside.
The extensive handout is easy to follow and includes a composite reference sheet to use in the session and post on the clinical unit afterwards. In addition, “In My Pocket” cards are included as a ready reference tool.
BrainyNurses.com by Educational Concepts, LLC
PAGES
SOCIAL
