Tuesday, November 25, 2008

T wave abnormality: cardiac or cerebral?

In 1954 George Burch described T wave abnormalities as myocardial ischemia mimics in patients with a variety of acute cerebral insults. His classic paper, which popularized the term cerebral T waves, is available as free full text here. (Note the nine lead electrocardiograms recorded from the string galvanometer on photographic paper).

Fifty four years later we’re just beginning to understand the neurocardiac mechanisms. Those mechanisms, along with a few ECG examples, were recently reviewed in the American Journal of Emergency Medicine. An algorithm to help differentiate cardiac from cerebral T wave abnormalities is presented. However, considerable overlap between the patterns exists.

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