– T Wave Changes

– T Wave Changes

The basic components of an electrocardiogram:

An EKG can help disclose the presence of arrhythmias, heart block, prior myocardial infarction, cardiomyopathy (primary disease of heart muscle), left ventricular hypertrophy, and other conditions.

While not always diagnostic of a specific cardiac condition, an EKG abnormality can be a red flag to a potential problem and the need for further investigation.

The three basic components on an EKG tracing are the P wave, the QRS complex, and the T wave.

The P wave represents contraction of the atria, the top chambers of the heart, which pump blood to the ventricles, the bottom chambers of the heart.

The QRS complex represents contraction of the ventricles, the bottom chambers of the heart, which pump blood throughout the body.

The T wave represents repolarization, or resetting of the ventricles, to prepare them for the next heart beat.


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T wave abnormalities can be divided into minor and major changes, based upon the appearance of the T waves. A minor T wave change refers to a T wave that is not as tall as expected or perhaps flat. A major T wave change implies that it is inverted. A major T wave change is usually more concerning than a minor T wave change.

T wave changes usually are not diagnostic for a particular condition, and the underwriter needs to correlate the findings with the available information. Clues might be provided by location of the T wave abnormalities, the medical history, the family history, and the stability of the T wave changes.

For examples, major T wave changes in someone with uncontrolled hypertension would be suggestive of left ventricular hypertrophy, while similar changes in a young applicant with a family history of sudden death could represent cardiomyopathy.

When a case is rated or postponed for T wave changes, favorable cardiac evaluation can often result in reconsideration.

Case Studies:

Applicant 1 is 39 years old and has no known cardiac risk factors. The insurance EKG had minor T wave changes. An APS revealed no significant medical history and had prior EKG tracings that look similar to the current EKG. This case can be Preferred Plus.

Applicant 2 is 35 years old, and had major T wave changes on the insurance EKG. The applicant’s father and brother both died suddenly before age 40. The applicant denied any medical history and did not have a doctor. The case was postponed and evaluation revealed the presence of cardiomyopathy and serious ventricular arrhythmias. This case is a decline.

Applicant 3 is 45 years old and had major T wave changes on the insurance EKG. An APS did not contain any cardiac information. The case was postponed for further evaluation. A negative treadmill report was submitted that made no mention of abnormal T waves. The actual treadmill tracings were requested and reviewed and led to the conclusion that the insurance EKG findings were inconsequential. This case can be Preferred Plus.

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