ECG Diagnosis: Hyperacute T Waves

ECG Diagnosis: Hyperacute T Waves

Joel T Levis, MD, PhD, FACEP, FAAEM

Perm J 2015 Summer; 19(3):79 [Full Citation]

https://doi.org/10.7812/TPP/14-243

After QT prolongation, hyperacute T waves are the earliest-described electrocardiographic sign of acute ischemia, preceding ST-segment elevation.1 Hyperacute T waves are broad-based and symmetrical, usually with increased amplitude and often associated with a depressed ST take off.1 Hyperacute T waves are most evident in the anterior chest leads and are more apparent when a previous electrocardiogram is available for comparison.2 Hyperacute T waves are noted early after the onset of coronary occlusion and transmural infarction and tend to be a short-lived structure that evolves rapidly into ST-segment elevation.3 The electrocardiographic differential diagnosis of the hyperacute T wave includes both transmural acute myocardial infarction and hyperkalemia as well as early repolarization, left ventricular hypertrophy, and acute myopericarditis.4

The principle entity to exclude is hyperkalemia—this T-wave morphology may be confused with the hyperacute T wave of early transmural myocardial infarction. In contrast to hyperacute T waves associated with myocardial ischemia or infarction, hyperkalemic T waves tend to be narrow and peaked with a prominent or sharp apex.4 For patients presenting with hyperacute T waves in the setting of suspected myocardial ischemia or infarction, treatment includes symptomatic control with nitroglycerin or morphine, oral antiplatelet agents (aspirin), consideration of anticoagulation with unfractionated heparin, and obtaining frequent serial 12-lead electrocardiograms (every 5 to 10 minutes). Prompt consultation with a cardiologist is indicated in these cases.

ECG Diagnosis: Hyperacute T Waves

References
1.    Goldberger AL. Hyperacute T waves revisited. Am Heart J 1982 Oct;104(4 Pt 1):888-90. DOI: https://doi.org/10.1016/0002-8703(82)90038-2.
    2.    Nable JV, Brady W. The evolution of electrocardiographic changes in ST-segment elevation myocardial infarction. Am J Emerg Med 2009 Jul;27(6):734-46. DOI: https://doi.org/10.1016/j.ajem.2008.05.025.
    3.    Morris F, Brady WJ. ABC of clinical electrocardiography: acute myocardial infarction—part I. BMJ 2002;324:831. DOI: https://doi.org/10.1136/bmj.324.7341.831.
    4.    Brady W, Morris F. Electrocardiographic abnormalities encountered in acute myocardial infarction. J Accid Emerg Med 2000 Jan;17(1):40-45. DOI: https://doi.org/10.1136/emj.17.1.40.

etoc emailClick here to join the eTOC list or text TPJ to 22828. You will receive an Email notice with the Table of Contents of each issue.

The Permanente Journal advances knowledge in scientific research, clinical medicine and innovative health care delivery. It is a peer-reviewed journal of medical science, social science in medicine, and medical humanities.

The Permanente Press

The Permanente Press publishes The Permanente Journal and books related to health care. For information about subscriptions, missing issues, billing, subscription renewal, and back issues, Email: permanente.journal@kp.org.

Circulation

27,000 print readers per quarter, 15,350 eTOC readers, and in 2018, 2 million page views of TPJ articles in PubMed from a broad international readership.

CME

The Kaiser Permanente National CME Program designates this journal-based CME activity for 4 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


ISSN 1552-5767 Copyright © 2019 thepermanentejournal.org.

All Rights Reserved.