9 morphology of t

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9 morphology of t

  1. 1. 12-Lead Electrocardiography a comprehensive course Adam Thompson, EMT-P, A.S.
  2. 2. T Wave • Should not be symmetrical. • Should be upright in every lead but aVR. • Height should correlate with QRS. • Should have a dull peak.
  3. 3. Symmetrical T-WaveAsymmetrical NormalSymmetrical Abnormal
  4. 4. Hyperkalemia Peaked T-Wave• Hyperkalemia = High Potassium Level – Peaked T-Waves • May mimic an acute MI – Sine Waves • Sign of lethally high potassium level Sine Wave
  5. 5. Hyperkalemia
  6. 6. Hyperkalemia
  7. 7. Hyperkalemia
  8. 8. 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.
  9. 9. T-Wave Discordance
  10. 10. 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
  11. 11. QT-Interval Normal QTc < 460 ms
  12. 12. QT-Interval QT QTc = RRMeasures the time from when depolarization starts to the end of repolarization.
  13. 13. QT-Interval
  14. 14. Long QT Syndrome• QTc > 460ms – Congenital • Major contributor to sudden unexplained death in children and young adults. – Drug induced • Caused by many arrhythmia medications
  15. 15. Long QT Syndrome
  16. 16. U-Wave • Usually not visible. • Should not be prominent. • Should never be bigger than T-wave
  17. 17. Osborn Waves• Sometimes called “J-Waves”• Indicates HYPOTHERMIA• May be associated with bradycardia• Extra wave at the J-Point of the QRS- complex.
  18. 18. Osborn Waves Osborn Waves
  19. 19. END• Up Next, STE-Mimics

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