Inverted u waves

• Usually occur in lateral leads

  • • > 0.5 mm depth

• Highly specific for heart disease

• Most commonly associated with:

  • • Hypertensive heart disease

    • AV and MV disease

    • Ischemic heart disease

    • Unstable angina

    • Variant angina

• During exercise testing, U-wave inversion was 93% specific (but only 21% sensitive) marker for LAD stenosis

  • • Gerson, Circulation 1979

• In the setting of cardiac ischemia…

  • • Association with LAD (or LMCA?) disease

    • May occur during pain or painless state

References:

1. Gerson MC, Philips JF, Morris SN, et al. Exercise-induced U-wave Inversion as a Marker of Stenosis of the Left Anterior Descending Coronary Artery. Circulation. 1979. PMID: 487534

2. Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric. 6^th Edition. Amazon link.

3. Sovari AA, Farokhi F, Kocheril AG. Inverted U wave, a specific electrocardiographic sign of cardiac ischemia. Am J Emerg Med. 2007. PMID: 17276833

4. Gerson MC, McHenry PL. Resting U Wave Inversion as a Marker of Stenosis of the Left Anterior Descending Coronary Artery. Am J Med. 1980. PMID: 7424944

5. Marriott HJL. Emergency Electrocardiography. 1997. Amazon Link.

6. Tamura A, Watanabe T, Nagase K, et al. Significance of Negative U Waves in the Precordial Leads During Anterior Wall Acute Myocardial Infarction. Am J Cardiol. 1997. PMID: 9104902