The U Wave

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Articles
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Media
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Evidence Based Medicine
Cochrane Collaboration on The U Wave Bandolier on The U Wave TRIP on The U Wave
Clinical Trials
Ongoing Trials on The U Wave at Clinical Trials.gov Trial results on The U Wave Clinical Trials on The U Wave at Google
Guidelines / Policies / Govt
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Commentary
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Definitions
Definitions of The U Wave
Patient Resources / Community
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Healthcare Provider Resources
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Continuing Medical Education (CME)
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Overview

U waves were described by Einthoven in 1903 and normally have same polarity as T waves^[1]

Pathophysiology

There are three hypotheses regarding the origin of the U wave^[1]:

1. Late repolarization of Purkinje fibers,
2. Late repolarization of some other portions of left ventricle,
3. Alteration in the normal action potential shape by after potentials.

Appearance

1. Ordinarily the U wave has the same polarity as the T wave and is 5 to 25% of the T wave amplitude.
2. Tallest in leads V2 and V3, usually not greater than 1.0 mm.
3. Considered abnormally large if the U wave is greater than 1.5 mm in any lead.^[1]

Differential Diagnosis of Causes of Abnormal U wave Prominence

• Bradycardia
• CNS disease
• Drugs such as:

• amiodarone
• digitalis
• disopyramide
• epinephrine
• phenothiazines
• procainamide
• quinidine

• Electrolyte imbalance

• Hypokalemia
• Hypomagnesemia
• Hypercalcemia

• Hyperthyroidism
• Left ventricular hypertrophy
• Long QT syndrome
• Mitral valve prolapse

Differential Diagnosis of Causes of U Wave Inversion

1. Left ventricular hypertrophy (in I, V5, V6)
2. Right ventricular hypertrophy (in II, III)
3. Ischemic heart disease

• May occur during anginal episode
• U wave inversion during an exercise tolerance test is considered indicative of ischemia by some

References

Additional resources

• ECGpedia: Course for interpretation of ECG
• The whole ECG - A basic ECG primer
• 12-lead ECG library
• Simulation tool to demonstrate and study the relation between the electric activity of the heart and the ECG
• ECG information from Children's Hospital Heart Center, Seattle
• ECG Challenge from the ACC D2B Initiative
• National Heart, Lung, and Blood Institute, Diseases and Conditions Index
• A history of electrocardiography
• EKG Interpretations in infants and children

v • d • e Electrocardiography
Overview	History of the EKG • EKG interpretation basics • Normal sinus rhythm
EKG Complexes	P wave • QRS complex • ST Segment • T wave • U wave Osborn wave • H wave • K wave • Delta wave NSSTW changes
EKG Intervals	PR Interval • QRS Interval • ST Interval • QT Interval
Conduction System & Bradycardia	Cardiac pacemaker • SA node • AV node• Bundle of His • Purkinje fibers • Sinus bradycardia • First Degree AV Block • Second Degree AV Block • Complete or Third-Degree AV Block • Concealed conduction • AV Junctional Rhythms • LBBB • LAHB • LPHB • RBBB • Trifascicular block
Atrial Arrhythmias	Sinus tachycardia • Premature Atrial Contractions (PACs) • Ectopic Atrial Rhythm • Paroxysmal Atrial Tachycardia (PAT) • Paroxysmal Atrial Tachycardia (PAT) with Block • Multifocal Atrial Tachycardia (MAT) • Atrial Flutter • Atrial Fibrillation • Wandering atrial pacemaker
Ventricular Arrhythmias	Differential Diagnosis of Tachycardia with a Wide QRS Complex • Accelerated Idioventricular Rhythm • Ventricular Parasystole • Premature Ventricular Contractions (PVCs) • Ventricular tachycardia • Ventricular Fibrillation • Sudden cardiac death
EKG Abnormalities in Disease States	Hypertrophy & Dilatation • Right atrial enlargement • Left atrial enlargement • Biatrial enlargement • Left Ventricular Hypertrophy • Right Ventricular Hypertrophy • Biventricular Hypertrophy • Acute myocardial infarction • NSTEMI • STEMI • Right ventricular myocardial infarction • Atrial infarction Pre-excitation Syndromes • Wolff-Parkinson-White Syndrome • Lown Ganong Levine Syndrome • Mahaim Type Preexcitation Cardiomyopathies • Arrhythmogenic Right Ventricular Dysplasia • Dilated Cardiomyopathy • Hypertrophic Cardiomyopathy Drug Effects on the EKG • Adenosine • β-blockers • Digitalis • Quinidine • Procainamide • Disopyramide • Lidocaine • Tocainide and Mexiletine • Phenytoin • Encainide, Flecainide and Propafenone • Amiodarone • Bretylium • Ca Channel Blockers • Phenothiazines • Tricyclic Antidepressants • Lithium Congenital Heart Disease • Dextrocardia • Atrial Septal Defect • Ventricular Septal Defect • Tetralogy of Fallot • Conjoined Twins or Siamese Twins Electrolyte Disturbances • Hyperkalemia • Hypokalemia • Hypercalcemia • Hypocalcemia • Nonspecific Changes Other Heart Diseases • Pericarditis • Myocarditis • Tamponade • Heart Transplantation • Sick Sinus Syndrome • Long QT Syndrome Inherited Disease • Brugada Syndrome Systemic Diseases • CNS Disease • Cardiac Tumors Heart Transplantation • EKG Changes in patient with Heart Transplantation Exogenous Effects • Hypothermia • Chest Trauma • Insect Bites • Electric Injuries
Technical Issues and Potential Errors in Interpretation	Artifacts • Lead Placement Errors • The EKG in a Patient with a Pacemaker

v • d • e WikiDoc Research Resources for The U Wave
Articles on The U Wave	Most recent articles on The U Wave • Most cited articles on The U Wave • Review articles on The U Wave • Articles on The U Wave in N Eng J Med, Lancet, BMJ
Media (Slides, Video, Images, MP3) on The U Wave	Powerpoint slides on The U Wave • Images of The U Wave • Photos of The U Wave • Podcasts & MP3s on The U Wave • Videos on The U Wave
Evidence Based Medicine Regarding The U Wave	Cochrane Collaboration on The U Wave • Bandolier on The U Wave • TRIP on The U Wave
Cost Effectiveness of The U Wave	Cost Effectiveness of The U Wave
Clinical Trials Involving The U Wave	Ongoing Trials on The U Wave at Clinical Trials.gov • Trial results on The U Wave • Clinical Trials on The U Wave at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding The U Wave	US National Guidelines Clearinghouse on The U Wave • NICE Guidance on The U Wave • NHS PRODIGY Guidance • FDA on The U Wave • CDC on The U Wave
Textbook Information on The U Wave	Books and Textbook Information on The U Wave
Pharmacology Resources on The U Wave	Dosing of The U Wave • Drug interactions with The U Wave • Side effects of The U Wave • Allergic reactions to The U Wave • Overdose information on The U Wave • Carcinogenicity information on The U Wave • The U Wave in pregnancy • Pharmacokinetics of The U Wave •
Genetics, Pharmacogenomics, and Proteinomics of The U Wave	Genetics of The U Wave • Pharmacogenomics of The U Wave • Proteomics of The U Wave
Newstories on The U Wave	The U Wave in the news • Be alerted to news on The U Wave • News trends on The U Wave
Commentary on The U Wave	Blogs on The U Wave
Patient Resources on The U Wave	Patient resources on The U Wave • Discussion groups on The U Wave • Patient Handouts on The U Wave • Directions to Hospitals Treating The U Wave • Risk calculators and risk factors for The U Wave
Healthcare Provider Resources on The U Wave	Symptoms of The U Wave • Causes & Risk Factors for The U Wave • Diagnostic studies for The U Wave • Treatment of The U Wave
Continuing Medical Education (CME) Programs on The U Wave	CME Programs on The U Wave
International Resources on The U Wave	The U Wave en Espanol • The U Wave en Francais
Business Resources on The U Wave	The U Wave in the Marketplace • Patents on The U Wave
Informatics Resources on The U Wave	List of terms related to The U Wave

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Acknowledgement and Attribution Regarding Sources of Content

Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .