💓ECG झाला सोप्पा💓भाग - 13 वा

 💓ECG झाला सोप्पा💓
भाग - 13 वा

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🌹डॉ पद्मनाभ केसकर
EMERGENCY MANAGEMENT EXPERT , Pune
मोबाईल - ९७६२२५८६५०

✅ या भागात आपण T wave रिलेटेड Abnormalities ची चर्चा करणार आहोत. मागील तीन भागात आपण ECG मध्ये ST segment related abnormalities काय काय मिळतात त्या कशा ओळखायच्या , त्याची कारणे व त्याची ट्रीटमेंट बघितली .

🍁T wave

✅T wave ही ईसीजी वर Ventricular relaxation म्हणजेच Ventricular repolarisation represent करते.

The T wave is the positive deflection after each QRS complex.

It represents ventricular repolarisation.

T wave ही सर्व लीडमध्ये Upright असते म्हणजेच वरच्या दिशेने जाणारी असते ( except- aVR and V1 )

©️ Dr Padmanabh Keskar

🍁Amplitude ( उंची )
Limb leads मध्ये 5 mm पेक्षा कमी आणि precordial leads ( V1 to V6 )  मध्ये 10 mm पेक्षा कमी .

🍁T wave abnormalities🍁

1) Peaked T waves
2) Hyperacute T waves
3) Inverted T waves
4) Biphasic T waves
5) ‘Camel Hump’ T waves
6) Flattened T waves

आता आपण वरील  Abnormality ची चर्चा  ECG  pattern सह करू.

🌷1) Peaked T wave
( सोबतचा ECG बघा )

Tall , Narrow,  Symmetrical , Peaked P wave .

अशा प्रकारच्या Tall , Tented , Peaked T wave या Hyperkalemia ( Raised Potassium level ) असल्यास मिळतात.
©️ Dr Padmanabh Keskar

🌷2) Hyperacute T waves
( सोबतचा ECG बघा )

Broad, asymmetrically peaked or ‘hyperacute’ T-waves are seen in the early stages of ST-elevation MI (STEMI) and often precede the appearance of ST elevation and Q waves.

म्हणजेच अशा स्वरूपाच्या Hyperacute T wave ECG मध्ये मिळाल्या तर ते Myocardial Infarction चे अर्थातच STEMI चे early sign असते . याच Hyperacute T wave नंतर ST ELEVATION मध्ये कन्व्हर्ट होतात.

They are also seen with Prinzmetal angina.

Peaked T wave आणि Hyperacute T wave मध्ये फरक म्हणजे Peaked T wave या Symmetrical असतात तर Hyperacute T wave या Asymmetrical असतात .

The normal T wave in V1 is inverted.

🛑An upright T wave in V1 is considered abnormal — especially if it is tall (TTV1), and especially if it is new (NTTV1).

This finding indicates a high likelihood of coronary artery disease, and when new implies acute ischemia.

✅म्हणजेच थोडक्यात V1 लीडमध्ये T wave Inverted असण्याऐवजी Upright असेल आणि ती Tall असेल तर पेशंटला Coronary Artery Disease / Acute Ischemia असण्याची शक्यता असते . हे ECG मधील  वॉर्निंग साइन समजावे .
©️ Dr Padmanabh Keskar

🌷3) Inverted T waves

✅Normally T wave या ईसीजी मध्ये वरच्या दिशेने ( Upright) जाणाऱ्या असतात . ( अपवाद लीड III )

जर का ECG मध्ये खालच्या दिशेने जाणाऱ्या ( Inverted) T wave  मिळाल्या तर खालील शक्यता उत्पन्न होतात.

🌸Inverted T waves are seen in the following conditions -

✅Normal finding in children
✅Myocardial ischaemia and infarction
✅Bundle branch block
✅Ventricular hypertrophy (‘strain’ patterns)
✅Pulmonary embolism
✅Hypertrophic cardiomyopathy
✅Raised intracranial pressure

🍁T wave inversion in lead III is a normal variant.

🍁New T-wave inversion (compared with prior ECGs) is always abnormal.

🍁Pathological T wave inversion is usually symmetrical and deep (>3mm).

🛑NOTE:

✅Dynamic T-wave inversions are seen with acute myocardial ischaemia.

✅Fixed T-wave inversions are seen following infarction, usually in association with pathological Q waves.

©️ Dr Padmanabh Keskar

🍁T wave Inversion in Bundle Branch Block
( सोबतचा ईसीजी बघा )

✅Left bundle branch block ( LBBB ) produces T-wave inversion in the lateral leads - I, aVL and V5-6.

✅Right bundle branch block ( RBBB ) produces T-wave inversion in the right precordial leads -  V1-V3

🍁T wave inversion in Ventricular Hypertrophy
( सोबतचा ईसीजी बघा )

✅Left ventricular hypertrophy (LVH)

LVH produces T-wave inversion in the lateral leads - I, aVL, V5-6 (left ventricular ‘strain’ pattern), with a similar morphology to that seen in LBBB.

✅Right ventricular hypertrophy ( RVH ) -

RVH produces T-wave inversion in the right precordial leads V1-V3 (right ventricular ‘strain’ pattern) and also the inferior leads (II, III, aVF).
©️ Dr Padmanabh Keskar

🍁T wave Inversion in Pulmonary Embolism ( PE )

Acute right heart strain (e.g. secondary to massive pulmonary embolism) produces a similar pattern to RVH.

T-wave inversions in the right precordial (V1-3) and inferior (II, III, aVF) leads.

S1Q3T3 pattern in Pulmonary Embolism
( सोबतचा ECG बघा )

SI QIII TIII

Pulmonary embolism may also produce -

S wave in lead I, Q wave in lead III, T-wave inversion in lead III

©️ Dr Padmanabh Keskar

🍁T wave Inversion in Raised intracranial pressure (ICP)
( सोबतचा ECG बघा )

Events causing a sudden rise in intracranial pressure (e.g. subarachnoid haemorrhage) produce widespread deep T-wave inversions with a bizarre morphology.

©️ Dr Padmanabh Keskar

🌷4) Biphasic T waves

There are two main causes of biphasic T waves:

1) Myocardial ischaemia
2) Hypokalaemia

✅In Biphasic T wave -  two waves go in opposite directions:

Biphasic T waves due to ischaemia – T waves go UP then DOWN
( सोबतचा ईसीजी बघा )

Biphasic T waves due to Hypokalaemia – T waves go DOWN then UP
( वरील ईसीजी बघा )

🌸5) Wellens Syndrome

Wellens syndrome is a pattern of inverted or biphasic T waves in V2-V3 (in patients presenting with/following ischaemic sounding chest pain) that is highly specific for critical stenosis of the left anterior descending artery.

©️ Dr Padmanabh Keskar

There are two patterns of T-wave abnormality in Wellens syndrome: ( सोबतचा ईसीजी बघा )

Type A = Biphasic T waves with the initial deflection positive and the terminal deflection negative (25% of cases)

Type B = T-waves are deeply and symmetrically inverted (75% of cases)

Note: The T waves evolve over time from a Type A to a Type B pattern

🌷6) Camel hump’ T waves
( सोबतचा ईसीजी बघा )

‘Camel hump’ T waves is a term used by Amal Mattu to describe T-waves that have a double peak. ( उंटाच्या पाठीवरील दोन उंचवटे सारखे ) 

©️ Dr Padmanabh Keskar

There are two causes for camel hump T waves:

✅1) Prominent U waves fused to the end of the T wave, as seen in severe hypokalaemia.


✅2) Hidden P waves embedded in the T wave, as seen in sinus tachycardia and various types of heart block.

🌷7) Flattened T wave

म्हणजे T wave चे उंचवटे व्यवस्थित न दिसता ते जवळपास flat झालेले असतात.

©️ Dr Padmanabh Keskar

🍁Flattened T waves are a non-specific finding, but may represent

Ischaemia (if dynamic or in continuous leads)  Biphasic T waves due to ischaemia – T waves go UP then DOWNads)
or
Electrolyte abnormality, e.g. hypokalaemia (if generalised).

🍁Hypokalaemia म्हणजे पोटॅशियमची  रक्तातील पातळी कमी होणे . या कंडिशन मध्ये सुद्धा T wave Flattened होते.
( सोबतचा ईसीजी बघा )

✅पुढील भागामध्ये आपण QT Interval विषयी माहिती घेऊ.

( ©️ You can forward my posts   with my name and without editing any content of it )

🌹डॉ पद्मनाभ केसकर
EMS Instructor , Ruby Hall Clinic , Pune
मोबाईल - ९७६२२५८६५०