Normalisation of Inverted T-Waves
In patients with flat or inverted T-waves at rest, the evolution to an upright T-wave has been considered by some to be a sign of ischaemia. This phenomenon has been labeled by some, as pseudo-normalisation of the T-wave. Bellet and Colleagues reported this evolution, in patients with clear out angina and considered it to indicate ischaemia. Many patients with inverted T- waves on the basis of metabolic abnormalities will manifest upright T-waves at the time of exercise. This is particularly true in women.
Peaked T-Waves
Exercise induced increase in T-wave amplitude in V2 is quite predictive of anterior wall ischaemia (specificity = 95 percent). It appears that this may be a forme fruste of ST elevation in the same lead, which is believed to be due to transmural ischaemia.
Deep T Inversion
T-wave inversion induced by exercise is almost always associated with significant ST-segment depression and has been identified with a more severe form of coronary disease. An excellent report by Chikamore confirms previous reports that it is usually associated with triple vessel disease and is reported to have a specificity of 96 per cent.
Tall T-Wave
It has been reported that tall T-wave during or after exercise indicate inferior wall ischaemia.However, Ellestad reports the findings that tall T-waves in the external precordial leads after exercise are a normal result of an increased stroke volume and are usually seen in subjects with a normal myocardium. This phenomenon is seen in many healthy teenage boys immediately after the exercise period. At this time, the pulse drops very rapidly, and it appears that the stroke volume must increase to make up for the lingering metabolic debt. The increased prevalence of tall T-waves in the younger age groups weights heavily against it being an abnormal finding.When this T-wave pattern occurs with exercise, ischaemic due to LAD artery narrowing is likely.
In patients with flat or inverted T-waves at rest, the evolution to an upright T-wave has been considered by some to be a sign of ischaemia. This phenomenon has been labeled by some, as pseudo-normalisation of the T-wave. Bellet and Colleagues reported this evolution, in patients with clear out angina and considered it to indicate ischaemia. Many patients with inverted T- waves on the basis of metabolic abnormalities will manifest upright T-waves at the time of exercise. This is particularly true in women.
Peaked T-Waves
Exercise induced increase in T-wave amplitude in V2 is quite predictive of anterior wall ischaemia (specificity = 95 percent). It appears that this may be a forme fruste of ST elevation in the same lead, which is believed to be due to transmural ischaemia.
Deep T Inversion
T-wave inversion induced by exercise is almost always associated with significant ST-segment depression and has been identified with a more severe form of coronary disease. An excellent report by Chikamore confirms previous reports that it is usually associated with triple vessel disease and is reported to have a specificity of 96 per cent.
Tall T-Wave
It has been reported that tall T-wave during or after exercise indicate inferior wall ischaemia.However, Ellestad reports the findings that tall T-waves in the external precordial leads after exercise are a normal result of an increased stroke volume and are usually seen in subjects with a normal myocardium. This phenomenon is seen in many healthy teenage boys immediately after the exercise period. At this time, the pulse drops very rapidly, and it appears that the stroke volume must increase to make up for the lingering metabolic debt. The increased prevalence of tall T-waves in the younger age groups weights heavily against it being an abnormal finding.When this T-wave pattern occurs with exercise, ischaemic due to LAD artery narrowing is likely.
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