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(Circulation. 1967;36:708.)
© 1967 American Heart Association, Inc.

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Tall Upright T Waves in the Precordial Leads

IVAN J. PINTO M.D., (BOM.), M.R.C.P. (LOND.), M.R.C.P. (EDIN.), F.A.C.C. (U.S.A.)¹; N. C. NANDA M.D. (BOM.)¹; A. K. BISWAS M.B., B.S.¹; V. G. PARULKAR M.B., B.S., M.SC. (MED.)¹

¹ From the Departments of Medicine and Physiology, Seth G. S. Medical College, and the Department of Cardiology, K.E.M. Hospital, and the Bombay Hospital, Bombay-12, India.

One hundred ten cases of T waves more than 10 mm in height in the precordial leads were studied. The T waves were wide in ischemic heart disease and thin and peaked in uremia. Marked changes in the ventricular gradient were observed in ischemic heart disease and in uremia with hyperkalemia. In other conditions, the changes in the ventricular gradient were of a lesser degree. In cases of left ventricular hypertrophy, the T waves were tall from V₁ to V₄ in systolic (pressure) overloading, from V₄ to V₆ in diastolic (volume) overloading, and from V₂ to V₆ in combined types of overloading.

The appearance of tall T waves was the earliest electrocardiographic sign encountered in clinical and experimental cases of acute myocardial infarction. In anterior myocardial infarction they disappeared within 24 hours indicating initial transient ischemia, while in angina pectoris and posterior myocardial infarction they lasted for a longer time probably due to persistent subendocardial ischemia.

Key Words: Ventricular gradient • Ventricular hypertrophy • Uremia • Angina pectoris • Hyperkalemia • Myocardial infarction