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The shape of the T wave is usually asymmetrical with a rounded peak. T wave inversions from V2 to V4 leads are frequently found and normal in children. In normal adults, T wave inversions from V2 to V3 are less commonly found but can be normal. [4] The depth of the T wave also becomes progressively shallow from one to the next lead. [5]
Normal sinus rhythm produces the prototypical pattern of P wave, QRS complex, and T wave. Generally, deviation from normal sinus rhythm is considered a cardiac arrhythmia . Thus, the first question in interpreting an ECG is whether or not there is a sinus rhythm.
Schematic representation of normal ECG. In electrocardiography, the ST segment connects the QRS complex and the T wave and has a duration of 0.005 to 0.150 sec (5 to 150 ms). It starts at the J point (junction between the QRS complex and ST segment) and ends at the beginning of the T wave.
R-peak time for right ventricle is measured from leads V1 or V2, where upper range of normal is 35 ms. R wave peak time for left ventricle is measured from lead V5 or V6 and 45 ms is the upper range of normal. [7] R wave peak time is considered to be prolonged if it's more than 45 ms.
ST segment depression and T-wave changes may be seen in patients with unstable angina; Depressed but upsloping ST segment generally rules out ischemia as a cause. Also, it can be a normal variant or artifacts, such as: Pseudo-ST-depression, which is a wandering baseline due to poor skin contact of the electrode [3]
By convention, the term "normal sinus rhythm" is taken to imply that not only are the P waves (reflecting activity of the sinus node itself) normal in morphology but that all other ECG measurements are also normal. [3] [5] Criteria therefore include: Normal heart rate (classically 60 to 100 beats per minute for an adult).
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Hyperacute T waves need to be distinguished from the peaked T waves associated with hyperkalemia. [16] In the first few hours the ST segments usually begin to rise. [17] Pathological Q waves may appear within hours or may take greater than 24 hr. [17] The T wave will generally become inverted in the first 24 hours, as the ST elevation begins to ...
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