Persistent juvenile T-wave pattern
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 precordial leads V1, V2, and V3 along with an early repolarization pattern. Shallow T-wave inversion is usually found in the right precordial leads (V1-V3) during infancy. T wave then 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 with 2 years, and the cases 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 waves 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 or prior MI.
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 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 complex.
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
Juvenile T wave pattern typically shows asymmetric T wave inversion in V1-V3 without ST segment elevation.
Treatment
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