Deep, symmetrical ("giant") T waves can be seen in a limited number of conditions.


A giant inverted T wave is > 5 mm deep and symmetrical.


Causes of giant inverted T waves:

(1) apical hypertrophic cardiomyopathy (Yamaguchi syndrome)

(2) elevated intracranial pressure or intracranial hemorrhage

(3) myocardial ischemia (cocaine-induced, etc)

(4) bundle branch block

(5) Wolff-Parkinson-White (WPW) syndrome

(6) idiopathic global T-wave inversion syndrome

(7) post-tachycardia (associated with supraventricular or ventricular tachycardia)

(8) post-pacemaker

(9) following truncal vagotomy

(10) following bilateral carotid endarterectomy

(11) large pulmonary embolus


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