Electrocardiographic T‐ and U‐Wave Discordance

Reinig, Michael; Harizi, Robert; Spodick, David H.

doi:10.1111/j.1542-474x.2005.00596.x

Cited by 17 publications

(10 citation statements)

References 19 publications

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“…In MI patients, four types of “abnormal” U waves with respect to the preceding T wave were identified and labeled following the designation first introduced by Reinig et al However, we found more complicated patterns with negative U waves especially in T‐U‐ and T+U‐ types.…”

Section: Discussionmentioning

confidence: 99%

U Wave Features in Body Surface Potential Mapping in Post–Myocardial Infarction Patients

Wang

Korhonen

Tierala

et al. 2013

Noninvasive Electrocardiol

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Section: Discussionmentioning

confidence: 99%

U Wave Features in Body Surface Potential Mapping in Post–Myocardial Infarction Patients

Wang

Korhonen

Tierala

et al. 2013

Noninvasive Electrocardiol

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“…The apparent ‘T–U’ complex in hypokalaemia is the result of interruption of the descending limb of T wave due to the interplay of opposing voltage gradients between epicardial, endocardial and M cells. Spodick and colleagues were the first to study clinical significance of U waves in relation to the T waves 16. They divided patients into three groups: negative T–U concordance (both T and U waves negative), type 1 T–U discordance (negative T waves and positive U waves) and type 2 T–U discordance (positive T waves and negative U waves).…”

Section: Discussionmentioning

confidence: 99%

Discordant U waves in the setting of hyperkalaemia

Chhabra¹,

Spodick

2013

BMJ Case Reports

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SUMMARYPhysiological U wave genesis occurs likely secondary to either late repolarisation of Purkinje fibres, or late repolarisation of some myocardial cells and/or delayed after depolarisation of the ventricular wall occurring during ventricular filling. Hypokalaemia has a wellknown association with pathological 'U wave' which actually combines with the T wave (TU complex) and results from slowing of phase 3 of the action potential with resultant electrical interaction between the three myocardial layers. U waves usually tend to disappear in the setting of hyperkalaemia. We report an unusual case where hyperkalaemia and discordant U waves coexisted. We believe that this may have occurred as a result of partial clinical adaptation of cardiac myocytes to the long-standing effects of hyperkalaemia as the patient had underlying history of chronic kidney disease. We also discuss the possible mechanisms of the U wave genesis and the importance of different U wave morphologies encountered in the real clinical practice. BACKGROUND

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“…(5) The negative T wave usually deep may be accompanied by positive or negative U waves. 27,28 The cases with positive U wave (T and U discordance) are seen more frequently in the absence of IHD, than the cases with negative T and U wave (T-U concordance; Fig. 8).…”

Section: The Negative T Wave Of Ischemic Origin Has the Following Chamentioning

confidence: 96%

Negative T Wave in Ischemic Heart Disease: A Consensus Article

Luna¹,

Zaręba

Fiol

et al. 2014

Noninvasive Electrocardiol

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Background: For many years was considered that negative T wave in ischemic heart disease represents ischemia and for many authors located in subepicardial area.Methods: We performed a review based in the literature and in the experience of the authors commenting the real significance of the presence of negative T wave in patients with ischemic heart disease.Results: The negative T wave may be of primary or secondary type. Negative T wave observed in ischemic heart disease are of primary origin, therefore not a consequence of abnormal repolarization pattern. The negative T wave of ischemic origin presents the following characteristics: (1) are symmetrical and of variable deepness; (2) present mirror patterns; (3) starts in the second part of repolarization; and (4) may be accompanied by positive or negative U wave. The negative T wave of ischemic origin may be seen in the following clinical settings: (1) postmyocardial infarction due to a window effect of necrotic zone and (2) as a consequence of reperfusion in case of aborted MI when the artery has opened spontaneously, or after fibrinolysis, PCI, or coronary spasm.Conclusion: Acute ongoing ischemia do not cause negative T wave. This pattern appears when the ongoing ischemia is vanishing or in the chronic phase. In all these cases the cause of negative T wave is not located in the subepicardial area. Furthermore, positive exercise testing is expressed by ST depression never by isolated negative T wave. There are many circumstances that may present negative T wave outside ischemic heart disease and that have been discussed in this paper.

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Electrocardiographic T‐ and U‐Wave Discordance

Cited by 17 publications

References 19 publications

U Wave Features in Body Surface Potential Mapping in Post–Myocardial Infarction Patients

U Wave Features in Body Surface Potential Mapping in Post–Myocardial Infarction Patients

Discordant U waves in the setting of hyperkalaemia

Negative T Wave in Ischemic Heart Disease: A Consensus Article

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