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Persistent juvenile T-wave pattern

Persistent juvenile T wave

Normal T Wave
ECG and Persistent Juvenile T Waves
Differential Diagnosis

Normal T Wave

Concordant T Wave

ECG abnormal disconcordance T wave, positive QRS, negative inverted T wave

Disconcordant T Wave

The T wave is the most variable wave on the ECG

Represents ventricular repolarization
Is low and wide

Is concordant (has the same polarity as the QRS)

Positive QRS - positive T wave
Negative QRS - negative T wave

Is positive (I, II, V3-V6)

Can be isolated negative (III, aVL)

Is negative (aVR)
Amplitude

In limb leads < 5mm
In chest leads < 15mm

For ECG diagnostics, the dynamic nature of the T wave is important

If the T wave is consistently the same - it often does not indicate a serious condition
If the T wave changes - it often indicates a serious condition (ischemia)

ECG and Persistent Juvenile T Waves

ECG (V1-V3) persistent juvenile T wave pattern (PJTWP), inverted T wave

Occur primarily in African-American women under 30 years old

Present from childhood and persist into adulthood (do not change)

Likely caused by hemodynamic right ventricular overload

during intrauterine development

Common in athletes
Patients do not have structural heart damage
ECG and Persistent Juvenile T Waves

Seen in leads V1-V3

In children under 12 years, they can also be present in V4

Are asymmetric inverted T waves
Are deep < 3mm (most common, but not a rule)

Differential Diagnosis

Ischemia in the anterior leads (V1-V3)

Ischemia also causes inverted T waves
These T waves, however, have dynamics and will disappear with the resolution of ischemia

Arrhythmogenic Right Ventricular Dysplasia (ARVD)

ARVD also causes inverted T waves (V1-V3) without dynamics, but ARVD has

Epsilon waves
Ventricular tachycardias
Ventricular extrasystoles with a pattern of LBBB

ECG (V1-V4) persistent juvenile T wave pattern, african-american female

Persistent Juvenile T Waves

A 32-year-old African-American woman without structural heart disease
Had the same T waves (V1-V4) on EKG 7 years ago
Inverted T waves (V1-V4)
- Depth < 3mm
The T waves did not change on repeated EKG recordings (it was not ischemia)

ECG (V1-V3) persistent juvenile T wave pattern, shallow asymmetric morphology inversions T waves (V1-V3), no significant ST segment

Persistent Juvenile T Waves

It was a 5-year-old healthy child without structural heart disease
Inverted T waves (V1-V2)
- Depth < 3mm
The T waves did not change in repeated EKG checks

ECG (V1-V3) persistent juvenile T wave pattern (PJTWI), Benign T wave inversion (BTWI), assymetric T wave inversion

Persistent Juvenile T Waves

It was an 11-year-old healthy child without structural heart disease
Inverted T waves (V1-V2)
- Depth < 3mm
The T waves did not change in repeated EKG checks

ECG (V1-V3) persistent juvenile T wave pattern (PJTWI)

Persistent Juvenile T Waves

It was a 20-year-old healthy woman without structural heart disease
Inverted T waves (V1-V3)
- Depth < 3mm (sometimes the depth can exceed 3mm)
The T waves did not change in repeated EKG checks

ECG (V1-V3) arrhythmogenic right ventricular hypertrophy, epsilon wave, inverted T wave

Arrhythmogenic Right Ventricular Dysplasia

Epsilon wave in all leads

It is characteristic of arrhythmogenic right ventricular dysplasia

Negative T waves (V1-V3), including V4-6
Hypertrophy and overload of the right ventricle

R/S ratio (V1) ≥ 1
Descending ST segment and Negative T waves (V1-4) (II, III, aVF)

Heart stenosis: Circumflex branch of left coronary artery (LCx), Anterior interventricular branch of left coronary artery (LAD)

ECG ischemic inverted T waves, unstable angina pectoris, stenosis LAD, LCx

Inverted Ischemic T Waves and Unstable Angina Pectoris

The patient had unstable angina pectoris due to stenosis of the LAD and LCx

ST depression (V4-V6)
Inverted T waves (V2-V6)
After stent placement (recanalization), the T waves normalized later

For acute subendocardial ischemia, the following are characteristic

ST depression and Inverted T waves (at least in 2 contiguous leads)

Persistent juvenile T waves are only present in leads (V1-V3)

Sources

ECG from Basics to Essentials Step by Step
litfl.com
ecgwaves.com
metealpaslan.com
medmastery.com
uptodate.com
ecgpedia.org
wikipedia.org
Strong Medicine
Understanding Pacemakers

Home /

Persistent juvenile T-wave pattern

Persistent juvenile T wave

Normal T Wave
ECG and Persistent Juvenile T Waves
Differential Diagnosis

Normal T Wave

The T wave is the most variable wave on the ECG

Represents ventricular repolarization
Is low and wide

Is concordant (has the same polarity as the QRS)

Positive QRS - positive T wave
Negative QRS - negative T wave

Is positive (I, II, V3-V6)

Can be isolated negative (III, aVL)

Is negative (aVR)
Amplitude

In limb leads < 5mm
In chest leads < 15mm

For ECG diagnostics, the dynamic nature of the T wave is important

If the T wave is consistently the same - it often does not indicate a serious condition
If the T wave changes - it often indicates a serious condition (ischemia)

Concordant T Wave

Disconcordant T Wave

ECG and Persistent Juvenile T Waves

Occur primarily in African-American women under 30 years old

Present from childhood and persist into adulthood (do not change)

Likely caused by hemodynamic right ventricular overload

during intrauterine development

Common in athletes
Patients do not have structural heart damage
ECG and Persistent Juvenile T Waves

Seen in leads V1-V3

In children under 12 years, they can also be present in V4

Are asymmetric inverted T waves
Are deep < 3mm (most common, but not a rule)

Differential Diagnosis

Ischemia in the anterior leads (V1-V3)

Ischemia also causes inverted T waves
These T waves, however, have dynamics and will disappear with the resolution of ischemia

Arrhythmogenic Right Ventricular Dysplasia (ARVD)

ARVD also causes inverted T waves (V1-V3) without dynamics, but ARVD has

Epsilon waves
Ventricular tachycardias
Ventricular extrasystoles with a pattern of LBBB

Persistent Juvenile T Waves

A 32-year-old African-American woman without structural heart disease
Had the same T waves (V1-V4) on EKG 7 years ago
Inverted T waves (V1-V4)
- Depth < 3mm
The T waves did not change on repeated EKG recordings (it was not ischemia)

Persistent Juvenile T Waves

It was a 5-year-old healthy child without structural heart disease
Inverted T waves (V1-V2)
- Depth < 3mm
The T waves did not change in repeated EKG checks

Persistent Juvenile T Waves

It was an 11-year-old healthy child without structural heart disease
Inverted T waves (V1-V2)
- Depth < 3mm
The T waves did not change in repeated EKG checks

Persistent Juvenile T Waves

It was a 20-year-old healthy woman without structural heart disease
Inverted T waves (V1-V3)
- Depth < 3mm (sometimes the depth can exceed 3mm)
The T waves did not change in repeated EKG checks

Arrhythmogenic Right Ventricular Dysplasia

Epsilon wave in all leads

It is characteristic of arrhythmogenic right ventricular dysplasia

Negative T waves (V1-V3), including V4-6
Hypertrophy and overload of the right ventricle

R/S ratio (V1) ≥ 1
Descending ST segment and Negative T waves (V1-4) (II, III, aVF)

Inverted Ischemic T Waves and Unstable Angina Pectoris

The patient had unstable angina pectoris due to stenosis of the LAD and LCx

ST depression (V4-V6)
Inverted T waves (V2-V6)
After stent placement (recanalization), the T waves normalized later

For acute subendocardial ischemia, the following are characteristic

ST depression and Inverted T waves (at least in 2 contiguous leads)

Persistent juvenile T waves are only present in leads (V1-V3)

Sources

ECG from Basics to Essentials Step by Step
litfl.com
ecgwaves.com
metealpaslan.com
medmastery.com
uptodate.com
ecgpedia.org
wikipedia.org
Strong Medicine
Understanding Pacemakers