Persistent juvenile T-wave pattern: Difference between revisions
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==Overview== | ==Overview== | ||
The Juvenile T-wave pattern refers to a normal electrocardiographic variant in which [[T wave inversions]] are present in precordial leads V<sub>1</sub>, V<sub>2</sub>, and V<sub>3</sub> along with an [[early repolarization pattern]]. Shallow T-wave inversion is usually found in the right precordial leads | The Juvenile T-wave pattern refers to a normal electrocardiographic variant in which [[T wave inversions]] are present in the right precordial leads (V<sub>1</sub>, V<sub>2</sub>, and V<sub>3</sub>) along with an [[early repolarization pattern]]. Shallow T-wave inversion is usually found in the right precordial leads during infancy, and T wave rises upwards during childhood. If this inverted T-wave pattern sustained to adulthood, it is called persistent juvenile T-wave pattern. | ||
== | == Historical Perspective == | ||
Juvenile T- | The term Juvenile T-wave pattern was first introduced by American physician David Littman in 1946. <ref name="pmid20996765">{{cite journal| author=LITTMANN D| title=Persistence of the juvenile pattern in the precordial leads of healthy adult Negroes, with report of electrocardiographic survey on three hundred Negro and two hundred white subjects. | journal=Am Heart J | year= 1946 | volume= 32 | issue= | pages= 370-82 | pmid=20996765 | doi=10.1016/0002-8703(46)90797-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20996765 }}</ref> | ||
==Natural History, Complications, Prognosis== | |||
Juvenile T-wave resolves completely in 98% of the patients, and those that persist into adulthood demonstrate no adverse sequela.<ref>{{cite journal|doi=10.1136/heartjnl-2018-BCS.71}}</ref> | |||
== Differentiating persistent Juvenile T-wave pattern from other causes of T-wave inversion == | == Differentiating persistent Juvenile T-wave pattern from other causes of T-wave inversion == | ||
* [[ | * Persistent juvenile T-wave inversion must be differentiated from other diseases that cause T-wave inversion, such as: | ||
* [[Arrhythmogenic RV dysplasia]] should be suspected if the inverted T wave persists beyond lead V<sub>1</sub> in a post pubertal male athlete. | |||
* [[Cerebrovascular accident|Cerebrovascular accidents]] can cause deep widely splayed T waves referred to as [[cerebral T waves]]. | |||
* [[Digoxin effect]] or [[Dig effect]] typically shows the following findings: | |||
* [[ | * [[Sinus bradycardia]] | ||
* [[T wave inversions|T-wave inversions]] | |||
* [[T waves flattening|T-wave flattening]] | |||
* [[U waves]] | |||
* [[PR prolongation]] | |||
* [[ST-segment depression]] with a “scooped” appearance | |||
* [[Short QT]] due to an abbreviated ventricular [[action potential]] | |||
* [[ | * [[Hypokalemia]] can cause T-wave inversion, ST-segment depression, QT prolongation, and U wave. | ||
* [[Ischemic heart disease]] including [[non ST segment elevation MI|non ST-segment elevation myocardial infarction]] causes [[ST depression|ST-segment depression]] and non-specific T wave changes. | |||
* [[Left bundle branch block]] shows the following criteria on ECG: | |||
* [[ | * [[QRS]] duration is equal or greater than 120 milliseconds | ||
* Absence of [[Q wave]] in leads I, V5 and V6 | |||
* Monomorphic R wave in I, V5 and V6 | |||
* T-wave deflection opposite to the major deflection of the [[QRS complex]] | |||
* [[Wellens' syndrome]] | * [[Left ventricular hypertrophy with strain]] is characterized by [[ST depression|ST-segment depression]] and T-wave inversion. | ||
* [[Myocarditis]] may cause [[sinus tachycardia]], diffuse T-wave inversion, [[ST segment elevation|ST-segment elevation]] without reciprocal depression, and [[low voltage QRS complexes]]. | |||
* [[Wolff-Parkinson-White syndrome]] ([[WPW]]) | * [[Premature ventricular contraction]] is characterized by premature beats in relation to the expected beat, which leads to abnormal morphology and duration of [[QRS complex|QRS complexes.]] | ||
* [[Pulmonary embolism]] may show inverted T wave in the anterior leads, particularly in massive pulmonary embolism. | |||
* [[Restrictive cardiomyopathy]] may show [[low voltage QRS complexes]] and inverted T waves. | |||
* [[Subarachnoid hemorrhage]] can cause [[ST-segment elevation]] and T-wave inversion.<ref name="pmid3797900">{{cite journal| author=Yernault JC, Rocmans P| title=[Indications and contraindications for surgery in bronchial cancer]. | journal=Rev Med Brux | year= 1986 | volume= 7 | issue= 8 | pages= 459-63 | pmid=3797900 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3797900 }}</ref> | |||
* [[Unstable angina]] may show inverted T wave and [[ST-segment depression]]. | |||
* [[Wellens' syndrome]] shows progressive symmetrical deep [[T wave inversion|T-wave inversion]] in leads V<sub>2</sub> and V<sub>3.</sub> | |||
* [[Wolff-Parkinson-White syndrome]] ([[WPW]]) typically shows slurred upstroke of the [[QRS complex]]—known as delta wave—and shortened P wave. | |||
== Epidemiology and Demographics == | == Epidemiology and Demographics == | ||
* Juvenile T wave pattern is more commonly seen in black people—it has been shown in 10.8% of black population and 0.3% of white subjects.<ref name="Wasserburger1955">{{cite journal|last1=Wasserburger|first1=Richard H.|title=Observations on the “juvenile pattern” of adult Negro males|journal=The American Journal of Medicine|volume=18|issue=3|year=1955|pages=428–437|issn=00029343|doi=10.1016/0002-9343(55)90223-0}}</ref> | * Juvenile T-wave pattern is more commonly seen in black people—it has been shown in 10.8% of black population and 0.3% of white subjects.<ref name="Wasserburger1955">{{cite journal|last1=Wasserburger|first1=Richard H.|title=Observations on the “juvenile pattern” of adult Negro males|journal=The American Journal of Medicine|volume=18|issue=3|year=1955|pages=428–437|issn=00029343|doi=10.1016/0002-9343(55)90223-0}}</ref> | ||
* Juvenile T wave pattern is more commonly found in females than males. <ref name="pmid9141601">{{cite journal| author=Assali AR, Khamaysi N, Birnbaum Y| title=Juvenile ECG pattern in adult black Arabs. | journal=J Electrocardiol | year= 1997 | volume= 30 | issue= 2 | pages= 87-90 | pmid=9141601 | doi=10.1016/s0022-0736(97)80014-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9141601 }}</ref><ref name="AshcroftMiller1971">{{cite journal|last1=Ashcroft|first1=M.T.|last2=Miller|first2=G.J.|last3=Beadnell|first3=H.M.S.G.|last4=Swan|first4=A.V.|title=A comparison of T-wave inversion, S-T elevation, and RS amplitudes in precordial leads of Africans and Indians in Guyana|journal=American Heart Journal|volume=81|issue=4|year=1971|pages=467–475|issn=00028703|doi=10.1016/0002-8703(71)90360-7}}</ref> | * Juvenile T-wave pattern is more commonly found in females than males. <ref name="pmid9141601">{{cite journal| author=Assali AR, Khamaysi N, Birnbaum Y| title=Juvenile ECG pattern in adult black Arabs. | journal=J Electrocardiol | year= 1997 | volume= 30 | issue= 2 | pages= 87-90 | pmid=9141601 | doi=10.1016/s0022-0736(97)80014-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9141601 }}</ref><ref name="AshcroftMiller1971">{{cite journal|last1=Ashcroft|first1=M.T.|last2=Miller|first2=G.J.|last3=Beadnell|first3=H.M.S.G.|last4=Swan|first4=A.V.|title=A comparison of T-wave inversion, S-T elevation, and RS amplitudes in precordial leads of Africans and Indians in Guyana|journal=American Heart Journal|volume=81|issue=4|year=1971|pages=467–475|issn=00028703|doi=10.1016/0002-8703(71)90360-7}}</ref> | ||
== Diagnosis == | == Diagnosis == | ||
=== Electrocardiogram === | === Electrocardiogram === | ||
Persistent juvenile T-wave pattern typically shows asymmetric T-wave inversion in V1-V3 without [[ST-segment elevation]]. | |||
== Treatment == | == Treatment == | ||
Persistent juvenile T-wave pattern can be normalized by the following medications: | |||
{| class="wikitable" | {| class="wikitable" | ||
!Medications | !Medications <ref name="pmid14349968">WASSERBURGER RH (1955) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14349968 Observations on the juvenile pattern of adult negro males.] ''Am J Med'' 18 (3):428-37. [http://dx.doi.org/10.1016/0002-9343(55)90223-0 DOI:10.1016/0002-9343(55)90223-0] PMID: [https://pubmed.gov/14349968 14349968]</ref> | ||
! | !Dosage | ||
|- | |- | ||
|Oral potassium bicarbonate-citrate | |Oral [[potassium bicarbonate]]-citrate | ||
|10 gm | |10 gm | ||
|- | |- | ||
Latest revision as of 00:29, 1 April 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Juvenile T waves
Overview
The Juvenile T-wave pattern refers to a normal electrocardiographic variant in which T wave inversions are present in the right precordial leads (V1, V2, and V3) along with an early repolarization pattern. Shallow T-wave inversion is usually found in the right precordial leads during infancy, and T wave rises upwards during childhood. If this inverted T-wave pattern sustained to adulthood, it is called persistent juvenile T-wave pattern.
Historical Perspective
The term Juvenile T-wave pattern was first introduced by American physician David Littman in 1946. [1]
Natural History, Complications, Prognosis
Juvenile T-wave resolves completely in 98% of the patients, and those that persist into adulthood demonstrate no adverse sequela.[2]
Differentiating persistent Juvenile T-wave pattern from other causes of T-wave inversion
- Persistent juvenile T-wave inversion must be differentiated from other diseases that cause T-wave inversion, such as:
- Arrhythmogenic RV dysplasia should be suspected if the inverted T wave persists beyond lead V1 in a post pubertal male athlete.
- Cerebrovascular accidents can cause deep widely splayed T waves referred to as cerebral T waves.
- Digoxin effect or Dig effect typically shows the following findings:
- Sinus bradycardia
- T-wave inversions
- T-wave flattening
- U waves
- PR prolongation
- ST-segment depression with a “scooped” appearance
- Short QT due to an abbreviated ventricular action potential
- Hypokalemia can cause T-wave inversion, ST-segment depression, QT prolongation, and U wave.
- Ischemic heart disease including non ST-segment elevation myocardial infarction causes ST-segment depression and non-specific T wave changes.
- Left bundle branch block shows the following criteria on ECG:
- QRS duration is equal or greater than 120 milliseconds
- Absence of Q wave in leads I, V5 and V6
- Monomorphic R wave in I, V5 and V6
- T-wave deflection opposite to the major deflection of the QRS complex
- Left ventricular hypertrophy with strain is characterized by ST-segment depression and T-wave inversion.
- Myocarditis may cause sinus tachycardia, diffuse T-wave inversion, ST-segment elevation without reciprocal depression, and low voltage QRS complexes.
- Premature ventricular contraction is characterized by premature beats in relation to the expected beat, which leads to abnormal morphology and duration of QRS complexes.
- Pulmonary embolism may show inverted T wave in the anterior leads, particularly in massive pulmonary embolism.
- Restrictive cardiomyopathy may show low voltage QRS complexes and inverted T waves.
- Subarachnoid hemorrhage can cause ST-segment elevation and T-wave inversion.[3]
- Unstable angina may show inverted T wave and ST-segment depression.
- Wellens' syndrome shows progressive symmetrical deep T-wave inversion in leads V2 and V3.
- Wolff-Parkinson-White syndrome (WPW) typically shows slurred upstroke of the QRS complex—known as delta wave—and shortened P wave.
Epidemiology and Demographics
- Juvenile T-wave pattern is more commonly seen in black people—it has been shown in 10.8% of black population and 0.3% of white subjects.[4]
Diagnosis
Electrocardiogram
Persistent juvenile T-wave pattern typically shows asymmetric T-wave inversion in V1-V3 without ST-segment elevation.
Treatment
Persistent juvenile T-wave pattern can be normalized by the following medications:
| Medications [7] | Dosage |
|---|---|
| Oral potassium bicarbonate-citrate | 10 gm |
| Intravenous pro-banthīne | 20–30 mg |
References
- ↑ LITTMANN D (1946). "Persistence of the juvenile pattern in the precordial leads of healthy adult Negroes, with report of electrocardiographic survey on three hundred Negro and two hundred white subjects". Am Heart J. 32: 370–82. doi:10.1016/0002-8703(46)90797-1. PMID 20996765.
- ↑ . doi:10.1136/heartjnl-2018-BCS.71. Missing or empty
|title=(help) - ↑ Yernault JC, Rocmans P (1986). "[Indications and contraindications for surgery in bronchial cancer]". Rev Med Brux. 7 (8): 459–63. PMID 3797900.
- ↑ Wasserburger, Richard H. (1955). "Observations on the "juvenile pattern" of adult Negro males". The American Journal of Medicine. 18 (3): 428–437. doi:10.1016/0002-9343(55)90223-0. ISSN 0002-9343.
- ↑ Assali AR, Khamaysi N, Birnbaum Y (1997). "Juvenile ECG pattern in adult black Arabs". J Electrocardiol. 30 (2): 87–90. doi:10.1016/s0022-0736(97)80014-3. PMID 9141601.
- ↑ Ashcroft, M.T.; Miller, G.J.; Beadnell, H.M.S.G.; Swan, A.V. (1971). "A comparison of T-wave inversion, S-T elevation, and RS amplitudes in precordial leads of Africans and Indians in Guyana". American Heart Journal. 81 (4): 467–475. doi:10.1016/0002-8703(71)90360-7. ISSN 0002-8703.
- ↑ WASSERBURGER RH (1955) Observations on the juvenile pattern of adult negro males. Am J Med 18 (3):428-37. DOI:10.1016/0002-9343(55)90223-0 PMID: 14349968