Page 182 - Clinical Pearls in Cardiology

170 Clinical Pearls in Cardiology

Fig. 8: Symmetrical and asymmetrical T wave inversion

• In patients whose T waves are already inverted, new
onset ischemia can cause reversal of the inversion.
So the previously inverted T waves may become
upright. This phenomenon is called as
“pseudonormalization of T wave”. This dynamic
change is a feature of ischemic T wave inversion.
• Positive-negative biphasic T wave with a minimally
elevated J point and an angle of 60 to 90 degrees
between the initial ascending portion and the
descending portion of the T wave [i.e. Wellens type
T-wave abnormality (Fig. 9)], is very specific for recent
myocardial infarction.

Fig. 9: Wellens type biphasic T wave (seen in leads V1 to V4)