🚨 Suggestive of OMI:
- Hyperacute T-waves currently have no formal ECG definition, but expert consensus and existing literature agree that they are likely best defined by increased AUC of the T-wave in proportion to the QRS amplitude (or perhaps QRS area).
- Subjectively, this corresponds to T-waves that are abnormally large by area (both height and width), bulky, and abnormally symmetric, as if being physically inflated, but all relative to QRS size.
- Objectively, increased AUC of the T-wave relative to the QRS has been shown by the following 2 quantifiable elements: 1) longer corrected QT interval, 2) greater T-wave to QRS amplitude ratio.
- An additional feature of hyperacute T-waves is increased and abnormal T-wave symmetry, which has not yet been well quantified.
- Evolution of hyperacute T wave Example
- Learn more about hyperacute T waves from this great review: 📄 PMID 36872197 – Smith, Stephen W., and Harvey Pendell Meyers. “Hyperacute T-waves Can Be a Useful Sign of Occlusion Myocardial Infarction if Appropriately Defined.” Annals of Emergency Medicine (2023).
✅ Mimics of hyperacute T wave:
- Reciprocal reperfusion T-waves (see example):
- How can you tell if a large upright wave is hyperacute or if it is reciprocal to an inverted wave? Answer: You can tell mostly based on the state of the patient. If the patient is symptomatic (should usually be chest pain), then the large fat T-wave is hyperacute. Serial ECGs should show evolution to STEMI in that lead. If, on the other hand, the patient is now pain free, then the ischemia is in the territory of the inverted T-wave and that is a reperfusion T-wave. The hyperacute T-wave is only a reciprocal view.
- How can you tell if a large upright wave is hyperacute or if it is reciprocal to an inverted wave? Answer: You can tell mostly based on the state of the patient. If the patient is symptomatic (should usually be chest pain), then the large fat T-wave is hyperacute. Serial ECGs should show evolution to STEMI in that lead. If, on the other hand, the patient is now pain free, then the ischemia is in the territory of the inverted T-wave and that is a reperfusion T-wave. The hyperacute T-wave is only a reciprocal view.
