13/04/2026
T-wave morphologies
The "T-WAVE" for Red Flags
• T – Tall/Tented: Hyperkalemia (Potassium is too high).
• W – Wellens/Biphasic: Sign of critical LAD stenosis (Ischemia).
• A – Asymmetrical Inversion: Left Ventricular "Strain" pattern.
• V – Very Flat: Nonspecific or Electrolyte imbalances.
• E – Extended/Prolonged: Long QT interval (Risk of Torsades).
Now let's go,
1. The Normal T-Wave
• Remember: Asymmetric, smooth, same direction as QRS.
• Key Note: The first half rises slowly, the second half drops quickly.
2. Nonspecific ST-T Abnormalities
• Biphasic: Goes both up and down. Often seen in Wellens Syndrome (ischemia) or hypokalemia.
• Bifid / Notched: Double peak. Can be seen in children (normal) or CNS events
• Broad / Slow: Wider than normal; can indicate ischemia or drug effects.
• Flat: Low voltage. Associated with hypokalemia, hypothyroidism, or ischemia.
3. Pathological Patterns (High Alert)
• Hyperkalemia:
• Remember: "Tall, Peaked, Tented."
• Visual: Looks like a sharp mountain peak you wouldn't want to sit on.
• Ischemia:
• Remember: "Deep, Symmetrical Inversion."
• Visual: Deep "V" shape. If it’s perfectly symmetrical, it’s highly suspicious for a heart attack.
• Strain:
• Remember: "Asymmetrical Inversion," "Checkmark shape."
• Key Note: Found in patients with high blood pressure or Valve disease (LVH/RVH).
• Prolonged QT Interval:
• Remember: "Delayed Repolarization."
• Visual: A long, flat ST segment before the T-wave finally shows up. Increases risk of sudden cardiac arrest.
Quick Note
• Is it too tall? Think Potassium (K+).
• Is it upside down (inverted)? Is it Ischemia (Symmetrical) or Strain (Asymmetrical)?
• Is it taking too long? Look at the QT Interval.
• Is it flat or weird? Think Electrolytes or nonspecific stress.
