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Prominent (Tall) T Waves

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Insights into Electrocardiograms with MCQs

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Abstract

Tall T waves can occur in some normal individuals and in athletes. Several cardiac disorders like acute coronary syndrome, recovering infarction left ventricular volume overload, and acute pericarditis can also produce prominent T waves. Intraventricular conduction defects and early repolarization syndrome can also produce prominent T waves. Noncardiac causes include cerebrovascular accidents and hyperkalemia. Different causes can affect different leads, produce different shapes of the T waves, and may be associated with different other electrocardiographic findings. Differentiating electrocardiographic features are discussed with representative electrocardiograms. Summary and MCQs at the end of the chapter help in quick revision and self-evaluation.

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References

  1. Wagner GS, Lim TH. Insufficient blood supply. In: Wagner GS, editor. Marriot’s practical electrocardiography. New Delhi: Wolters Kluwer; 2001. p. 163–207.

    Google Scholar 

  2. de Luna AB, Goldwasser D, Fiol M, Bayes-Genis A. Surface electrocardiography. In: Fuster V, Walsh RA, Harrington RA, editors. Hurst’s the heart. New York: McGraw Hill; 2011. p. 307–70.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Ex Senior professor and head of the department of cardiology, Jawaharlal Nehru Medical College, Ajmer, India

    Sitaram Mittal

Authors
  1. Sitaram Mittal
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Appendices

Summary

  • T waves may be relatively tall as a normal variant and in persons with vagotonia as in athletes.

  • Peaked, symmetrical, wider, and taller T wave in leads V1 to V4 are present in acute transmural ischemia in left anterior descending coronary artery territory or as a mirror image of the chronic phase of the inferoposterior Q wave myocardial infarction.

  • Left ventricular pressure overload and complete left bundle branch block produce tall T waves in leads V1 and V2 as reciprocal change of T wave inversions in leads V5, V6.

  • Peaked, symmetrical, tall T waves with narrow base are seen in hyperkalemia.

  • Prominent and broad T waves with a prolonged QTc interval are seen in sub-arachnoid hemorrhage or following Stokes–Adams’ syncopal attacks in high-grade atrioventricular block. Such changes are also seen following truncal vagotomy, radical neck dissection, or bilateral carotid endarterectomy.

  • Left ventricular diastolic overload (e.g., chronic moderately severe aortic or mitral regurgitation) produce mildly prominent T waves in leads V5 and V6.

  • In hypercalcemia, proximal limb of T wave acutely slopes to its peak. There is shortening of the ST-segment. ST-segment may not appear.

  • Acute pericarditis produces diffuse, mildly prominent T waves with mild elevation of the ST-segment, and mild depression of the PR segment.

MCQs

Q1. T wave in limb leads is considered tall if the amplitude is more than:

  1. (a)

    0.5 mV

  2. (b)

    1.0 mV

  3. (c)

    1.5 mV

  4. (d)

    Amplitude of the accompanying R wave

Q2. T wave in precordial leads is considered tall if amplitude is more than:

  1. (a)

    1.0 mV

  2. (b)

    1.5 mV

  3. (c)

    2.0 mV

  4. (d)

    Amplitude of the accompanying R wave

Q3. Normally the T wave can be taller than the r wave in leads:

  1. (a)

    II, III, aVF

  2. (b)

    V1, V2, V3

  3. (c)

    V5, V6

  4. (d)

    None

Q4. Prominent T waves in lead V5, V6 can be seen in:

  1. (a)

    Vagotonia

  2. (b)

    Anxiety

  3. (c)

    Hyperventilation

  4. (d)

    Hypoxia

Q5. In early repolarization syndrome:

  1. (a)

    J point is elevated

  2. (b)

    ST-segment is depressed

  3. (c)

    T wave is prominent

  4. (d)

    QT interval is prolonged

Q6. Prominent T waves are seen in:

  1. (a)

    Subendocardial ischemia

  2. (b)

    Subendocardial infarction

  3. (c)

    Hyperacute phase of myocardial infarction

  4. (d)

    Healed myocardial infarction

Q7. Prominent T waves in leads V1 and V2 are seen in:

  1. (a)

    LBBB

  2. (b)

    True posterior infarction

  3. (c)

    Anterior subendocardial infarction

  4. (d)

    Right ventricular infarction

Q8. Prominent T waves in leads I and aVL are seen in:

  1. (a)

    Recovering inferior infarction

  2. (b)

    Recovering high lateral infarction

  3. (c)

    Posterolateral infarction

  4. (d)

    Acute anterior infarction

Q9. Healing high lateral infarction can produce prominent T waves in:

  1. (a)

    Leads I and aVL

  2. (b)

    Leads III and aVF

  3. (c)

    Leads V5 and V6

  4. (d)

    Leads V1 to V4

Q10. Moderate left ventricular hypertrophy due to systemic hypertension can produce prominent T waves in:

  1. (a)

    Leads V1, V2

  2. (b)

    Leads V5, V6

  3. (c)

    Leads V7 to V9

  4. (d)

    None

Q11. Prominent T waves in leads V5 and V6 can be seen in:

  1. (a)

    Chronic severe aortic regurgitation

  2. (b)

    Severe aortic stenosis

  3. (c)

    Hyperacute lateral infarction

  4. (d)

    Chronic severe mitral regurgitation

Q12. Acute pericarditis produces:

  1. (a)

    Diffuse ST-segment elevation

  2. (b)

    Reciprocal ST-segment depression in leads II, III, aVF

  3. (c)

    PR segment elevation

  4. (d)

    All

Q13. Prominent and broad T waves with prolonged QT interval are seen in:

  1. (a)

    Cerebrovascular accident

  2. (b)

    Following Stokes–Adams’ attack

  3. (c)

    Acute subendocardial ischemia

  4. (d)

    All

Q14. Hyperkalemia produces:

  1. (a)

    Tall and pointed T waves

  2. (b)

    Broad T waves

  3. (c)

    Prolongation of the QT interval

  4. (d)

    All

Q15. Hyperkalemia produces:

  1. (a)

    Prolongation of the PR interval

  2. (b)

    Disappearance of the P wave

  3. (c)

    Atrioventricular block

  4. (d)

    All

Q16. Hyperkalemia produces:

  1. (a)

    Widening of the QRS complexes

  2. (b)

    Fusion of the QRS complexes and the T wave

  3. (c)

    Narrowing of the QRS complexes

  4. (d)

    Increase in QT interval

Q17. T waves relatively prominent than normal can be present:

  1. (a)

    As a normal variant

  2. (b)

    In vagotonia

  3. (c)

    In athletes

  4. (d)

    None

Q18. Tall, symmetrical, and wider T waves in leads V1 to V4 can be due to:

  1. (a)

    Acute transmural ischemia in LAD territory

  2. (b)

    Reciprocal changes of posterior myocardial infarction

  3. (c)

    LBBB

  4. (d)

    All

Q19. Complete LBBB produces tall T waves in leads:

  1. (a)

    V1, V2

  2. (b)

    V3, V4

  3. (c)

    V5, V6

  4. (d)

    V7, V8

Q20. Chronic moderately severe aortic regurgitation produces prominent T wave in leads:

  1. (a)

    V1, V2

  2. (b)

    V3, V4

  3. (c)

    V5, V6

  4. (d)

    V7, V8

Q21. Peaked, symmetrical, narrow, tall T waves with absent P wave, and broad QRS are seen in:

  1. (a)

    Cerebrovascular accident

  2. (b)

    Hyperkalemia

  3. (c)

    Hypercalcemia

  4. (d)

    Truncal vagotomy

Q22. Prominent T waves with broad base, bradycardia, and prolonged QTc interval are seen:

  1. (a)

    In subarachnoid hemorrhage

  2. (b)

    Following Stokes–Adams’ attacks

  3. (c)

    Following unilateral carotid endarterectomy

  4. (d)

    All

Q23. Radical neck dissection can produce:

  1. (a)

    Symmetrical, narrow, peaked T waves

  2. (b)

    Symmetrical, broad, prominent T waves with prolonged QTc interval

  3. (c)

    Prolonged QTc interval

  4. (d)

    Symmetrical wider and taller T waves

Q24. Diffuse mildly prominent T waves with mild ST-segment elevation and mild PR segment depression without reciprocal changes are seen in:

  1. (a)

    Hyperkalemia

  2. (b)

    Acute pericarditis

  3. (c)

    Pericardial constriction

  4. (d)

    Vagotonia

Q25. Electrocardiographic findings in athletes do not include:

  1. (a)

    Sinus tachycardia

  2. (b)

    Prolonged PR interval

  3. (c)

    Tall T waves

  4. (d)

    Prominent U waves

Q26. Electrocardiogram of an athlete can show:

  1. (a)

    Prominent respirophasic sinus arrhythmia

  2. (b)

    Early repolarization pattern

  3. (c)

    Left ventricular hypertrophy

  4. (d)

    None

Q27. Electrocardiogram of athlete cannot show:

  1. (a)

    Sinus bradycardia

  2. (b)

    First degree atrioventricular block

  3. (c)

    Mobitz type 1 second degree atrioventricular block

  4. (d)

    Flat T wave

Q28. Which electrocardiographic findings can be seen in athletes?

  1. (a)

    Incomplete right bundle branch block

  2. (b)

    Complete right bundle branch block

  3. (c)

    Complete LBBB

  4. (d)

    Mobitz type 2 second degree atrioventricular block

Q29. In left ventricular hypertrophy, leads V1 and V2 show:

  1. (a)

    Deep S wave

  2. (b)

    ST-segment elevation

  3. (c)

    Symmetrical tall T waves

  4. (d)

    Asymmetric tall T waves

Q30. In complete LBBB, leads V1 and V2 do not show:

  1. (a)

    QRS duration of less than 120 ms

  2. (b)

    Absence of initial r wave

  3. (c)

    Deep S waves

  4. (d)

    Asymmetric tall T wave

Q31. In initial stage, hyperkalemia produces:

  1. (a)

    Narrowing of the T wave

  2. (b)

    Peaking of the T wave

  3. (c)

    Prolongation of the QT interval

  4. (d)

    Absence of the P wave

Q32. Cerebrovascular accident can produce:

  1. (a)

    Bradycardia

  2. (b)

    Narrow and peaked P wave

  3. (c)

    Marked prolongation of the QT interval

  4. (d)

    Prominent U wave

Q33. Chronic moderate aortic regurgitation does not produce:

  1. (a)

    Tall T waves in leads V1, V2

  2. (b)

    Prominent T waves in leads V5, V6

  3. (c)

    Mild elevation of ST segment in leads V5, V6

  4. (d)

    Narrow deep q wave in leads V5, V6

Q34. Acute pericarditis does not produce:

  1. (a)

    Marked diffuse elevation of the ST-segment

  2. (b)

    Elevation of the PR segment

  3. (c)

    Mildly diffuse prominence of the T wave

  4. (d)

    U wave inversion

1.1 Answers

(1) a, d (2) a, d (3) b (4) a (5) a, c (6) a, c (7) a, b (8) a (9) b (10) a (11) a, c (12) a (13) d (14) a (15) d (16) a, b (17) a, b, c (18) a, b (19) a (20) c (21) b (22) a, b (23) b (24) b (25) a, d (26) a, b, c (27) d (28) a (29) a, b, d (30) a (31) a, b (32) a, c (33) a (34) a, b, d

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Mittal, S. (2023). Prominent (Tall) T Waves. In: Insights into Electrocardiograms with MCQs. Springer, Singapore. https://doi.org/10.1007/978-981-99-0127-2_43

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  • DOI: https://doi.org/10.1007/978-981-99-0127-2_43

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-99-0126-5

  • Online ISBN: 978-981-99-0127-2

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