Help with inverted T-waves/reciprocol

pricklypear · Mar 28, 2006

Can anyone help me with understanding inverted t waves in leads say V2, V3, V4 or V5. What does reciprocol changes mean?

I noticed you've had 32 views and no responses to your post!

I just got home from work, so please excuse my lame answer!

#1 Inverted T waves, or ST depression usually mean ischemia in the area of the heart associated with that lead. In other words, enough oxygen deprivation to cause irritation, but not permanant damage - the beginning of an MI.

#2 Reciprocal changes are opposite changes in leads across the heart. Anterior leads may show ST elevation, with posterior leads showing ST depression.

rarjn5 · Mar 28, 2006

Thank you pricklypear for your response. I appreciate the time put into responding because I know it still takes time out of your schedule. In response to your post, are all reciprocol changes inverted in configuration on a 12-lead? Or backwards. What about opposite of lateral leads? Where would reciprocol changes show up for lateral leads. And why does that happen? I know I have a lot of questions, maybe someone can add comments to assist in understanding. Thank you!

Reddy,RN · Mar 28, 2006

i can't answer your questions but i think this might have answers for you:

http://http://medlib.med.utah.edu/kw/ecg/index.html

it looks pretty comprehensive:

table of contents

[color=#003399]i.[color=#660000]the standard 12 lead ecg[color=#003399]

[color=#003399]ii.[color=#660000]a "method of ecg interpretation[color=#003399]

[color=#003399]iii.[color=#660000]characteristics of the normal ecg[color=#003399]

[color=#003399]iv.[color=#660000]ecg measurement abnormalities

[color=#003399]v.[color=#660000]ecg rhythm abnormalities[color=#003399]

[color=#003399]vi.[color=#660000]ecg conduction abnormalities

[color=#003399]vii.[color=#660000]atrial enlargement

[color=#003399]viii.[color=#660000]ventricular hypertrophy

[color=#003399]ix.[color=#660000]myocardial infarction

[color=#003399]x.[color=#660000]st segment abnormalities

[color=#003399]xi.[color=#660000]t wave abnormalities[color=#003399]

[color=#003399]xii.[color=#660000]u wave abnormalities

rarjn5 · Mar 28, 2006

Thank you Reddy! I started to look at the link and it looks like a lot of good information.

pricklypear · Mar 29, 2006

Thank you pricklypear for your response. I appreciate the time put into responding because I know it still takes time out of your schedule. In response to your post, are all reciprocol changes inverted in configuration on a 12-lead? Or backwards. What about opposite of lateral leads? Where would reciprocol changes show up for lateral leads. And why does that happen? I know I have a lot of questions, maybe someone can add comments to assist in understanding. Thank you!

Yes, reciprocal changes are opposite deflections. Definition: corresponding but opposite. This is just from my own head, but I think the significance of true reciprocal changes is that they disprove errors in lead placement, interference or artifact that could look like problems on a 12 lead. Reciprocal changes refers only to damage markers, like T wave and ST abnormalities. It just means that if you see signs of damage in V1, you should see opposite changes in V2. They appear opposite because the electrical impulses are being traced (or read) from opposite sides of the infarction. Help any?

What we need is Pawpawjohn to respond to this one.

rarjn5 · Mar 29, 2006

Thanks Pricklypear! I think my question is more complex to answer then I thought.

Editorial Team / Admin · Mar 29, 2006

hello, rarjn5,

check out the sticky i created which is found at the top of the page in this forum. there are links to ecg websites that will clear up much of any confusion you might have.

https://allnurses.com/forums/f15/helpful-information-unit-140706.html

papawjohn · Mar 30, 2006

Hey Y'all!!!

I've been away from the keyb'd a few days. Boat projects. I guess I'm late here. Thanx for thinking of me, BTW.

Here's the thing with any of those squiggly things from the ECG or the monitor--they're produced by the movement of electrolytes. In the case of the T-Wave, the electrolytes are being pulled and shoved into 'hyper-charged' spaces. The intra-cellular part of the cardiac muscle cell ends up ultra-full of Potassium and the extra-cellular fluid gets full of Sodium. This movement happens AGAINST THE GRADIENT!! Like pushing my old Volkwagen uphill. So lots of calories are expended and the mitochondria of cardiac cells are humming and glowing with energy in the T-Wave.

This--by the way--is why the first ECG signs of ischemia are in the T-Wave.

So the first thing I want to discover about your question is--you DO mean the T WAVE as opposed to the S-T SEGMENT, yes? The difference is important of course and I trust you to be asking about T WAVEs.

So why are some T-Waves inverted? Lots of reasons: Old scars. Hypertrophy. Electrolyte abnormalities.

It hardly ever 'means' anything acute about your Pt

But it gives us a chance to look at 12leads and electrolytes "ONE MORE TIME"--the only way I stay current.

Best to y'all

Papaw John

rarjn5 · Mar 30, 2006

Thank you Papawjohn. So just to recap: inverted T waves don't mean ischemia? Secondly: inverted T waves are not considered reciprocal changes. Thirdly: Do reciprocal changes correlate with specific areas of the heart? Such as anterior vs posterior changes? I don't know if I'm asking questions that I should know or complex questions. I'm fairly new to critical care nursing and work in a small ICU that has limited resources. Any comments are encouraged!

papawjohn · Mar 30, 2006

Hey Again!!!

Gosh, I kinda remember my prev note was kinda breezy--like: Know the difference between 'inverted T' and 'depressed S-T segment' and worry about the latter, don't worry about the former. Was essentially what I said.

I apologize. You had a much better question than that and I should have recognized it.

Lets begin with the 'ischemia' business 'cause that's what we're here to prevent. It shows up in the SEGMENT. Glance at some of the 'Acute MI' illustrations in the websites recommended and you'll see that infarction and ischemia don't just 'flip' a T-wave, they show distress along the whole re-polarization part of the cardiac cycle, which is of course the S-T segment.

Now if--in the middle of your shift you notice that your Pt's T-Wave's have 'flipped'--you would obviously investigate (start by checking lead placement--which you should have peeked at in your initial assessment) and one of the possibilities is ischemia. So, depending on your index of suspicion--you would possibly get a 12lead and a set of enzymes as well as completely reassessed and maybe moved up a notch on your 'worrisome patient' list.

Now, one of the ways you'd verify that some sort of electrical 'event' was going on with the change in the T-Wave is by looking for the SAME T-Wave deflection on the 12lead that the monitor shows--in the lead that the monitor is set on. OK? You see I'm using the 12lead as a check on the bedside screen. Assume we find the same 'flip'--we look on the 12lead for OPPOSITE CHANGES in leads that are OPPOSITE PLACEMENT or POLARITY.

Those are the 'reciprocal' changes you asked about. (Of course, we are comparing this 12lead to the Pt's 'baseline' ECG!!!)

And by the way--GREAT WORK noticing the 'flipped T' and following up on it.

Now having said all that--I've never found much significance to 'flipped Ts'. I see some folks that have 'flipped' Ts on admission, don't admit to having heart disease, have normal lab and electolytes--but they don't fit the "Normal 12 Lead EKG". Othertimes, subtle things that show up on the monitor are covered by other assessments; you know the K level this morning is going to be OK because you know what the T-Wave looked like when it was high--and since the T Wave is normal tonight you're comfortable with the Potassium in the IV. That's how I have mostly viewed those subltle monitor changes--well worth their weight as warnings but not totally diagnostic on their own.

Thanx for following up. Hope I 'splained it better.

Papaw John

rarjn5 · Mar 31, 2006

Thank you very much and you have helped me with the ongoing learning process of critical care nursing (or nursing in general)! And most of all just having the feedback from other nurses is a great encouragement.