upright T waves in v1

The normal ECG has a flat or inverted T-wave in lead V₁

• An upright T-wave in V₁ (TV₁) should be considered possibly abnormal

  • Marriott: If the TV₁ large (TV₁ > TV₆), it is particularly abnormal

  • “Loss of precordial T-wave balance”

  • Suggests underlying CAD

  • Suggests acute ischemia if new (new upright T wave in V_1, NUTV₁)

• New tall T-wave in V₁ (NTTV₁)

  • A type of hyperacute T-wave

  • This finding may precede other expected ischemic ECG changes

  • Worry about this in patients with active symptoms

  • Get serial ECGs

  • Beware for normal variants

    • Precordial lead reversals

    • LBBB

    • LVH

    • High left ventricular voltages