The T-wave should be concordant with the QRS complex, meaning that a net positive QRS complex should be followed by a positive T-wave, and vice versa (T-wave changes are notoriously misinterpreted, particularly inverted T-waves. Unter einer T-Inversion versteht man eine negative, d.h. dem Hauptaktionspotential entgegengesetzte T-Welle.Man spricht in diesem Fall auch von einer diskordanten T-Welle.. 2 Einteilung. In general, an inverted T wave in a single lead in one anatomic segment (ie, inferior, lateral, or anterior) is unlikely to represent acute pathology; for instance, a single inverted T The interpretation of the ECG in the context of the individual patient presentation is mandatory.
Isolated T-wave inversions also occur in leads V2, III or aVL. The T wave is normally upright in leads I, II, and V3 to V6; inverted in lead aVR; and variable in leads III, aVL, aVF, V1, and V2.

It is a general misunderstanding that T-wave inversions, without simultaneous ST-segment deviation, indicate acute (ongoing) myocardial ischemia. T-waves that are higher than 10 mm and 8 mm, in men and women, respectively, should be considered abnormal.

Assessment of the T-wave represents a difficult but fundamental part of ECG interpretation. Negative U-waves my occur when post-ischemic T-wave inversions are present. The T-wave is negative if its terminal portion is below the baseline, regardless of whether its other parts are above the baseline. aVR displays a negative T-wave.III and aVL: These leads occasionally display an isolated (single) T-wave inversion.V1: Inverted or flat T-wave is rather common, particularly in women. ECG changes can be variable and include: Sinus tachycardia. If the sum is greater than 35 mm in a patient older than 35 years, then the LVH by voltage pattern is diagnosed. Thus, T-wave inversions in leads V1 and V2 may be fully normal.
The inversion is concordant with the QRS complex. T-wave inversions may be present in all chest leads. For example, the T waves in patients who have sustained a CNS Left ventricular hypertrophy (LVH) by voltage pattern can be described via numerous ECG scoring systems. When it is seen in these patients, T-wave inversion usually indicates a resolving process. Secondary T-wave changes result from aberrant ventricular activation in the context of normal action potential characteristics; examples include bundle-branch blocks, ventricular pre-excitation states (eg, Wolff-Parkinson-White syndrome), ventricular paced rhythms, and ventricular ectopic beats. Usually, though, the amplitude in V2–V3 is around 6 mm and 3 mm in men and women, respectively. QRS / QT prolongation. AV conduction defects. Nonetheless, an isolated T-wave inversion in a single lead is not abnormal and, in fact, is considered a normal variant finding. In patients with LVH, ST-segment/T-wave changes are encountered in approximately 70% of cases, including ST-segment Patients with Wolff-Parkinson-White syndrome can present with ST-segment and T-wave abnormalities as well as abnormalities of the QRS complex; these findings are termed the “pseudo-infarction findings.” For example, Q waves may be seen in leads II, III, and aVF that mimic past inferior MI. The T-wave is normally slightly asymmetric since its downslope (second half) is steeper than its upslope (first half). This is referred to as T-wave memory or cardiac memory. T-wave inversions associated with coronary artery disease may result from myocardial ischemia (ie, unstable angina), non–ST-segment elevation acute myocardial infarction (NSTEMI-MI), or previous MI Patients with pulmonary embolism (PE) may also display T-wave abnormalities, including T-wave inversions Acute myocarditis and acute myopericarditis can present with a range of ECG abnormalities, including ST-segment elevation and T-wave inversion. Ventricular arrhythmias. This interpretation strategy allows the clinician to discern among normal, potentially abnormal, and abnormal.


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