T Wave Changes


In general, T wave changes are very non-specific. They can occur with hyperventilation, anxiety, drinking hot or cold beverages, and positional changes. Dramatic T wave inversions are often seen in the athletic heart syndrome (a constellation of findings not associated with any pathology), and the dramatic T wave inversions associated with CNS events are very rare. Hyperkalemia (hyperpotassemia) can cause tall, peaked T waves. Hypokalemia and ischemia can cause low amplitude or inverted T waves.


The patient presenting with T wave changes should be questioned regarding past or present symptoms of myocardial ischemia including chest pain. A history of athletic training, mental obtundation or a signs and symptoms of stroke could explain the findings. Physical findings of a cardiomyopathy could lead one to consider a hypertrophic cardiomyopathy. Apical hypertrophy is associated with deeply inverted T waves across the anterior precordium. Obtain blood chemistries including electrolytes, glucose, calcium, magnesium BUN, and creatinine.

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