A child with biphasic T waves in V1-V2

 Case submitted by Dr. Mike Runyon, written by Meyers, Grauer, and SmithA child between the ages of 5 and 10 was brought in by parents for new onset recurrent episodes that were interpreted as most likely panic attacks. Before arriving at that diagnosis, the providers wanted to make sure all other diagnosable causes were ruled out. An ECG was ordered and is shown below.What do you think?This was sent to me asking " What do you make of the T waves in V1 and V2? "I responded:" These T waves don ' t match any pathology I know of. I think they are likely just a meaningless normal variant. I ' ve seen some like it before, and I ' ve always failed to connect them with any pathology. "The ECG shows sinus rhythm with normal sinus P wave morphology, normal QRS axis and morphology for age, normal QT interval. There is a biphasic down-up T wave appearance in V1 and V2.I sent it to Dr. Smith and Dr. Grauer who both agreed, and taught me that this is named " bifid T waves. " Below is a link to a study on bifid T waveshttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726157/Study highlights: - they define bifid T waves as those that are " notched, being the 2 peaks separate from each other by a notch with duration greater than or equal to 0.02 sec and voltage greater than or equal to 0.05 mV " - they obtained an ECG on 604 consecutive children without known heart disease, then performed a " complete clinical and echocardiographic examination " on those with bifid T waves&nb...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs