Emergency Medicine Cases - B Jesse McLaren - May 2021
“Take home points on hyperacute T-aves and occlusion MI
- Tall T-waves can be a normal variants (including early repolarization), secondary to abnormal depolarization (LBBB, LVH), or a primary repolarization abnormality (hyperkalemia, occlusion MI)
- “Peaked T-waves” from hyperkalemia are diffuse, look pinched (narrow base, sharp peak), and are associated with other signs of hyperkalemia (brady, junctional rhythm, long PR, wide QRS)
- “Hyperacute T-waves” from OMI are regional, look inflated (wide base, round peak, large relative to the QRS), and are associated with other signs of occlusion like acute Q/loss of R waves, STE or reciprocal STD
- Variants of hyperacute T-waves include: upsloping STD + hyperacute T wave (deWinter T wave), and anterior QS waves with hyperacute T-waves (T/QRS>0.36, which differentiates from LV aneurysm)”