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Discussion

Abset/Flat T-wave

Hi all,

I had a patient and their EKG showed t-waves in some leads, however absent/flat t-waves in other leads. I can't remember all the leads, however I am sure that lead II did not have a T wave. It also looked like there might be a LBBB in a couple of the leads as well (would a true LBBB have to appear in all leads?)

Any idea why some of these waves my be flat? Could it be ischemia?

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    Found this in about 4 seconds with a Google search.

    T wave ECG Basics

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    You may have had the leads transposed.

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    You may have had the leads transposed.

    or anterior wall ischemia or hypokalemia.

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    Once you understand vectors, you'll have a more clear cut understanding on reading 12-lead EKGs. For BBB, V1 and V6 are the 2 only leads you should be looking at. They are the only 2 leads that will determine whether it's a LBBB or RBBB. Of course you will see the "rabbit" ears on other leads and all leads will be over 0.12 sec (widened QRS).

    Once you understand cardiac vectors, everything will start making sense.

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    When you look at a 12 lead you should consider all the leads. Though typically v1 and v6 are used to determine bbb quickly. Qrs must be >120msec for a lbbb v1 is typically a QS wave or rS wave. V6 is usually a R wave sometimes notched or m shaped. They have a mneumonic for it WiLLiaM MoRRoW

    W in v1 M in v6. = lbbb. M in v1 w in v6 =rbbb

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