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    5.6
    Home > ECG findings

    5.6

    Novacode 5.6: isolated major T-wave inversion without Q waves or LVH — ischaemia, cardiomyopathy and other causes.

    Code 5.6 (Novacode NC-5.6) — isolated major T-wave abnormality. The ECG shows significant T-wave inversion without pathological Q waves and without left ventricular hypertrophy. Together with NC-5.5, Novacode classifies this as isolated major ischaemia. Repolarisation is clearly abnormal, but there are no signs of a scar after infarction. The Minnesota equivalent is code 5-1 or 5-2.

    Novacode 5T-wave inversionMyocardial ischaemia
    Novacode criterionT-negativity score ≥ 20, Q-score < 15
    Exclusionno LVH
    Minnesota equivalent5-1 or 5-2
    Categorymajor ischaemia
    Normal complex compared with marked T wave inversion without Q wave Normal T upright NC-5.6 T inverted, no Q
    Figure 1. Left: normal complex. Right: marked T-wave inversion without pathological Q waves — isolated major T-wave abnormality (Novacode 5.6).

    Causes

    • Coronary artery disease, including the Wellens pattern (deep T in V2–V3 after chest pain)
    • Cardiomyopathies (hypertrophic, especially apical; arrhythmogenic right ventricular), myocarditis
    • Takotsubo cardiomyopathy, pulmonary embolism, intracranial events
    • Memory T waves after pacing or tachycardia; medicines; electrolyte disorders
    • Normal variants (juvenile pattern in V1–V3, some athletes)

    Clinical significance

    Major T-wave abnormalities without Q waves have been associated with increased cardiovascular risk in population studies. In young people, especially athletes, T inversion in the lateral or inferior leads requires exclusion of cardiomyopathy. In people with chest pain, deep T inversion may indicate a critical coronary stenosis.

    Call emergency services

    if you have or recently had chest pain, breathlessness or fainting.

    Planned evaluation

    Echocardiography and cardiology assessment are recommended; sometimes cardiac MRI is needed to exclude cardiomyopathy.

    References

    1. Rautaharju PM, Park LP, Chaitman BR, Rautaharju F, Zhang ZM. The Novacode criteria for classification of ECG abnormalities and their clinically significant progression and regression. J Electrocardiol. 1998;31(3):157–187.
    2. de Zwaan C, Bär FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J. 1982;103(4 Pt 2):730–736. doi:10.1016/0002-8703(82)90480-x
    3. Rautaharju PM, Surawicz B, Gettes LS. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval. Circulation. 2009;119(10):e241–e250. doi:10.1161/CIRCULATIONAHA.108.191096

    This article is for general information and does not replace a consultation with a doctor. ECG findings must be interpreted by a physician together with symptoms and other tests.

    Published on 14 May 2019