Welch Allyn Means ECG Physicians Manual for CP Series Electrocardiographs - User Manual - Manual (Page 27)

MEANS Physicians Manual
Welch Allyn
27
2.19 Repolarization
The negativity of the T wave in all leads except aVR and V1 is classified in one of the following
categories:
“flat or low negative”: positive T amplitude  50 µV and negative T amplitude  30 µV
“small negative”: 30 < negative T amplitude

100 µV
“negative”: 100 < negative T amplitude

250 µV
“large negative”: 250 < negative T amplitude

500 µV
“very large negative”: negative T amplitude > 500 µV
Using this negative T wave classification, repolarization statements can be made for five different
localizations: “inferior” (II, III, aVF), “high-lateral” (I, aVL), “right precordial” (V2, V3), “mid precordial”
(V3, V4, V5), and “left precordial” (V5, V6). The severity of a repolarization disturbance is indicated
by one of six possible grades: “minimal”, “minor”, “slight”, “moderate”, “marked”, “very marked”. The
grades of severity are determined by considering the negativity of the T wave in the leads that are
pertinent to a particular localization.
In general, the statement “very marked <loc> repolarization abnormality”, where <loc> denotes one of
the five localizations mentioned above, requires a large negative T wave in at least one of the leads
pertaining to that localization with additional less severe constraints on the remaining leads. In a
similar way, the statement “marked <loc> repolarization disturbance” requires a large negative T
wave in at least one of the relevant leads. Statements for “moderate“, “slight”, and “minimal”
repolarization abnormality require negative, small negative, and flat or low negative T waves,
respectively. Grade “minor” requires both small negative and flat or low negative T waves to be
present.
After each repolarization statement, a statement as to the cause of the repolarization disturbance is
appended. Depending on the T abnormalities found and possible other abnormalities, such as LVH
or infarction, the program may append one of the following statements:
“, consider ischemia”
“, consider ischemia or LV overload”
“, consider ischemia and/or digitalis”
“, consider ischemia, LV overload and/or digitalis”
“ secondary to infarct”
“, consider infarct of recent occurrence”
“ secondary to LVH”
“ secondary to LVH, consider also infarct”
“ secondary to LVH, consider also ischemia”
“ secondary to infarct, consider also LV overload”
“ secondary to RVH”
“ secondary to RBBB”
“ secondary to LBBB”
“, consider juvenile pattern”
“, consider feminine pattern”
“, compatible with early repolarization”
“, consider acute infarct occurrence”
“, consider acute ischemia”
“, probably reciprocal”
“, consider ischemia, or non-specific change”
“, secondary to RVH and/or juvenile pattern”
“, secondary to RBBB and/or juvenile pattern”
“, consider juvenile and/or feminine pattern”
“, consider feminine pattern and/or ischemia”
“, consider ischemia, LV overload or –non-specific change”
“, probably non-specific change”