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    68 Causes of T Wave ST Segment Abnormalities

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    Shri Mahalaxmi Harish
    This document lists 68 potential causes of abnormal T waves and ST segment changes on electrocardiograms (ECGs). [1] These abnormalities are often described as "non-specific" since they do not clearly indicate a specific medical condition. [2] The list includes electrolyte abnormalities, cardiac conditions, medications, and other clinical factors that could result in minor ECG deviations. [3] Evaluating these various possible underlying reasons can help interpret ECGs showing unusual but mild T wave or ST segment changes.

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    68 Causes of T Wave ST Segment Abnormalities

    Uploaded by

    Shri Mahalaxmi Harish
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    This document lists 68 potential causes of abnormal T waves and ST segment changes on electrocardiograms (ECGs). [1] These abnormalities are often described as "non-specific" since they do not clearly indicate a specific medical condition. [2] The list includes electrolyte abnormalities, cardiac conditions, medications, and other clinical factors that could result in minor ECG deviations. [3] Evaluating these various possible underlying reasons can help interpret ECGs showing unusual but mild T wave or ST segment changes.

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    68 Causes of t Wave St Segment Abnormalities

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    This document lists 68 potential causes of abnormal T waves and ST segment changes on electrocardiograms (ECGs). [1] These abnormalities are often described as "non-specific" since they do not clearly indicate a specific medical condition. [2] The list includes electrolyte abnormalities, cardiac conditions, medications, and other clinical factors that could result in minor ECG deviations. [3] Evaluating these various possible underlying reasons can help interpret ECGs showing unusual but mild T wave or ST segment changes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    61 views5 pages

    68 Causes of T Wave ST Segment Abnormalities

    Uploaded by

    Shri Mahalaxmi Harish
    This document lists 68 potential causes of abnormal T waves and ST segment changes on electrocardiograms (ECGs). [1] These abnormalities are often described as "non-specific" since they do not clearly indicate a specific medical condition. [2] The list includes electrolyte abnormalities, cardiac conditions, medications, and other clinical factors that could result in minor ECG deviations. [3] Evaluating these various possible underlying reasons can help interpret ECGs showing unusual but mild T wave or ST segment changes.

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    68 causes of T wave, ST segment


    abnormalities
    How o�en do you see an ECG that is just a little o�? Maybe the T wave is flat,
    oddly-shaped or inverted. Maybe the ST segment is coved, very minimally-
    depressed or shows some J point elevation.

    These are referred to as “non-specific” T wave and ST segment changes on


    the ECG because they are simply not specifically signaling any medical
    condition. Here, we consider the potentially-underlying reasons for these
    annoying minimal ECG changes and explore various clinical situations that
    could cause T waves and ST segments to deviate from normal.

    In some instances, T wave changes might suggest specific conditions, such as


    peaked T waves in hyperkalemia or symmetric T wave inversions during
    myocardial ischemia. But what about all the other T wave abnormalities,
    such as flat T waves, biphasic T waves or asymmetric T wave inversions?
    Similarly, ST segment abnormalities on the ECG can sometimes be due to a
    specific cause, such as ST segment elevation myocardial infarction,
    pericarditis or myocardial ischemia. Other times, there are just subtle
    abnormalities.

    Review the following ECG findings when the ST segment change or T wave
    change is actually indicative of a specific condition. These are very important
    not to misinterpret.

    ST Segment Elevation MI

    Pericarditis

    Hyperkalemia

    A�er reading the list below in entirety, you will completely understand why
    the T wave and ST segment changes mentioned above are sometimes called
    non-specific. Although some in their severe form have a more classic ECG
    appearance that could help pinpoint a diagnosis, every situation is di�erent.
    A mild abnormality (i.e. mild hyperkalemia or a very small MI) may only show
    a mild ECG change and not a full-blown abnormal finding. When a finding
    may sometimes be classic, it is listed next to the cause.

    1. Hypokalemia (ST segment depression, T-wave flattening)

    2. Hyperkalemia (multiple possible changes; when severe, classic


    finding is peaked T waves)

    3. Hypomagnesemia (flat, wide T waves; results in prolonged QT)

    4. Hypermagnesemia (increased T-wave amplitude)

    5. Hypercalcemia (short T wave with shortened QT interval; “J wave”


    when severe)

    6. Hypocalcemia (flat, wide T waves; results in prolonged QT)


    7. Hyponatremia (non-ischemic ST segment elevation)

    8. Memory T-wave abnormality post-pacing

    9. Memory T-wave abnormality post-rate-dependent BBB

    10. ST-T wave abnormalities associated with a LAFB

    11. ST-T wave abnormalities associated with LPFB

    12. ST-T wave abnormalities associated with LBBB

    13. ST-T wave abnormalities associated with RBBB

    14. ST-T wave abnormalities associated with NSIVCD

    15. ST-T wave abnormalities associated with WPW

    16. ST-T wave abnormalities associated with paced beats

    17. ST-T wave abnormalities associated with PVCs

    18. Myocarditis

    19. Myocardial ischemia (classic is significant ST segment depression;


    when mild, may be just a non-specific change)

    20. Myocardial infarction (non-ST segment elevation MI)

    21. VERY early myocardial injury (classic is “hyperacute T waves”)

    22. Reciprocal ischemic changes

    23. Le� ventricular aneurysm (classic is persistent ST segment elevation


    6 weeks a�er MI)

    24. Coronary spasm

    25. Digoxin

    26. Quinidine

    27. Tricyclic antidepressants (T-wave changes; classic is QRS widening)

    28. Many medication overdoses (see the below example of a clonidine


    overdose; this case looked like hyperacute T waves)
    29. Atrial flutter (flutter waves overlapping T waves)

    30. Infiltrative cardiomyopathy

    31. Takotsubo cardiomyopathy

    32. Hypertrophic obstructive cardiomyopathy

    33. Apical hypertrophic cardiomyopathy

    34. Arrhythmogenic right ventricular dysplasia

    35. Brugada syndrome

    36. Long QT syndromes

    37. LVH with strain

    38. RVH with strain

    39. Stage 3 pericarditis (T waves flattened)

    40. Cocaine toxicity

    41. Cardiac tumor

    42. Loe�ler’s endocarditis

    43. Hypothemia

    44. Mitral valve prolapse

    45. Pericardial e�usion

    46. Pericardial abscess

    47. Subarachnoid hemorrhage (deep inverted T waves, QT prolonged as


    well)

    48. Subdural hematoma (deep inverted T waves, QT prolonged as well)

    49. Intracranial hemorrhage (deep inverted T waves, QT prolonged as


    well)

    50. Stroke (deep inverted T waves, QT prolonged as well)

    51. Post carotid endarterectomy (deep inverted T waves, QT prolonged


    as well)

    52. Hyperventilation (can cause ST depression)

    53. Limb lead reversal

    54. ECG lead misplacement

    55. Physiologic junctional depression (occurs with sinus tachycardia)

    56. Pseudo ST-depression (wandering baseline from artifact, poor skin-


    electrode contact)

    57. Heightened adrenergic state (pain, panic attack, etc...)

    58. Early repolarization

    59. Hypothyroidism

    60. Truncal vagotomy

    61. Hypopituitarism

    62. Gallbladder disease

    63. Adrenal insu�iciency

    64. Pulmonary embolism

    65. Post-prandial

    66. Persistent juvenile T-wave pattern

    67. Le�-sided pleural e�usion

    68. Normal variant

    Every time you see an ECG with a T wave or ST segment that is not normal,
    use this list to identify the possible causes. There are likely additional
    scenarios I did not think to mention here; please use the comment section to
    add to the list.

    - by Steven Lome

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