The negative T wave in lead
aVL is one of the electrocardiographic features of left ventricular hypertrophy or myocardial infarction, associated with negative T wave in lead v
5, v
6 and I. Whereas the significance of isolated negative TaVL, not associated with other abnormal negative T wave, is of much controversial.
The electrocardiographic and vectorcardiographic changes of 146 cases were studied for appreciation of negative TaVL, whose TaVL were negative in 115 cases with or without negative ST, Tv
5, v
6, positive in 23 cases, and flat in 7 cases. The electrocardiographic diagnosis of left ventricular hypertrophy was found in 50 cases, of old myocardial infarction, in 24 cases, and the remaining were admitted to R
I>R
III group (41 cases) and to R
I<R
III group (31 cases).
In left ventricular hypertrophy and myocardial infarction, isolated negative TaVL was the sign of anterior or anteroinferior displacement of spatial T loop, indicating abnormal, possibly of ischaemic origin, lesion in lateral wall of left ventricle.
In R
I>R
III group, if associated with isolated negative TaVL, T
III>T
I and TV
I/TV
5≥0.74, the same displacement as in left ventricular hypertrophy and myocardial infarction was found, suggesting ischaemic change of lateral wall. In R
I<R
III group, if associated with isolated negative TaVL, T
III>T
I and TV
I/TV
5≥0.56, the spatial T loop was in anterior position, but with no pathological meaning.
Negative TaVL associated with R
I>R
III, T
III>T
I and TV
I/TV
5<0.74 or R
I<R
III, T
III>T
I and TV
I/TV
5<0.56, was sign of inferior, posteroinferior, posterior or normal position of spatial T loop, and abnormal T loop (spatial length/width≤2.6, abnormal speed of inscription, irregular shape, wide spatial QRS-T angle) was found more frequent in R
I>R
III group (66.7%) than in R
I<R
III group (35.3%).
Negative TaVL with negative ST, T change in V
5, v
6 was sign of right anterior, right anterosuperior, right posterosuperior displacement of spatial T loop, indicating more severe lesion of anterior or lateral wall.
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