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ECG Findings

  • Tall, often domed T waves.

  • T waves have asymmetric appearance.

  • T waves will often have a broad base.


  1. Hyperacute T waves occur very early during myocardial injury and are transient.

  2. The term “hyperacute T waves” is reserved for the early stages of MI.

  3. The presence of prominent T waves appearing to be “hyperacute” (ie, indicative of ischemia) is somewhat nonspecific and can also be found in patients with LVH, early repolarization, hyperkalemia, and a few other conditions. However, serial ECGs are useful in distinguishing ischemic T waves from other causes of prominent T waves. In the presence of ischemia, the ECG is likely to show evolving changes, thus confirming that the prominent T wave is a sign of ischemia. In the other conditions, evolving changes are less likely.


Hyperacute T Waves. T waves in a patient with acute myocardial ischemia. (ECG contributor: James V. Ritchie, MD.)


T waves (double arrow) are large in proportion to the QRS complex. The height was transient and was significantly diminished in a serial tracing obtained 15 minutes later. Note also in the 12-lead ECG example above the presence of inferior ST elevation.

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