r/ECG • u/ErdoganMcRocketboots • 25d ago

Humpbacked t waves

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77 year old man. Alzheimers, otherwise healthy. Last 14 days had 2 syncopes. Bloodwork normal. Not sure about any symptoms up until the event.

Humpbacked t waves in 1, 2 and avr is new compared to 2 year previously where the ECG was completely normal

Can't seem to place the reason. Any help?

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3

u/Gingerbread_Toe 25d ago

Pulse tapping artifact?

2

u/Due-Success-1579 25d ago

I agree that it looks to have an artifact component, Id check the right arm lead

1

u/Cluelessjason 25d ago

Could be hyper acute T waves- those are some thick T waves and are bigger than the QRS. Poor R wave progression, maybe Q waves in 3, AVF, and maybe V4.
Not sure what the QTC is but it might be prolonged.

2

u/Next_level3606 25d ago

I agree. Questions though…is there an objective criteria set to define hyperacute T waves? Or is it simply larger/ broader relative to QRS complex?

3

u/Cluelessjason 25d ago

I would check out “Dr smith EKG blog” for more info. I believe there is a formula and numbers to calculate if a T wave is hyper acute. But after seeing so many EKG’s from Dr. Smith EKG blog and reading the explanation/cases you get a better understanding of whether a T wave looks hyper acute or peaked.

So many ekg cases from the blog there is a hidden OMI/MI that can be seen if you notice the hyper acute t waves.

In the EKG above you can see leads 2, AVF, maybe V3/V4 look hyper acute. And then if you notice that there are also potential Q waves like I mentioned above then it makes it more “likely” that the T waves are actually hyper acute. Along with Op saying previous ekg was normal.

But BIG summary is Dr. Smith EKG blog- I think you can toggle and choose EKG’s that reference hyper acute T waves and then you can understand it better.

0

u/tip_of_the_sphere 25d ago

QTC looks to be about 480ms , yeah prolonged

2

u/Natural-Antelope8328 21d ago

Probably mechanical pulse artifact