Symposium on cardiology in aviation
Electrocardiographic findings in 67,375 asymptomatic subjects: VIII. Non-specific T wave changes

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Abstract

An electrocardiographic analysis of 67,375 asymptomatic healthy men on flying status with the U. S. Air Force has revealed the presence of 581 subjects with non-specific T wave changes in their routine electrocardiogram. Complete clinical evaluation of 226 subjects failed to reveal any increase of heart disease or family history of heart disease over what might be expected from a similar analysis of randomly selected men from the same population with normal electrocardiograms.

The types of T wave changes were categorized into nine basic patterns. An attempt to correlate these patterns with any characteristic of the subject or other features of his electrocardiogram was unrevealing.

Comparison of the group with non-specific T wave changes with a series of 6,000 normal electrocardiograms (1,000 from each five-year age group of the adult population) revealed many striking differences. The body weights and heart rates of the group with the abnormality were slightly higher than in those with normal values, and the percentage of overweight subjects in each age group was markedly larger. The T wave amplitude in leads I, aVF, V2 and V6 was approximately half that of comparable values in the normal series when each lead was compared separately and when sums of leads in the same plane were compared.

There was an increase in the incidence of non-specific T wave changes in the older age groups. This is likely due to increased cardiac disease expected at these ages.

A complete clinical evaluation was conducted on 226 of the 581 subjects with non-specific T wave changes. There were 121 (53.3 per cent) subjects whose fasting tracing was normal in all respects. In these, T wave changes were often artificially induced following ingestion of 100 gm. of glucose in solution, following orthostasis and with deep inspiration. These T wave changes mimicked the original abnormality seen on the routine survey electrocardiogram.

Obesity was a factor in the production of non-specific T wave changes in several subjects, but the presence of obesity did not preclude normal fasting electrocardiograms.

There were twenty-five subjects, whose T wave abnormality was attributed to increased heart rate and/or anxiety.

Because of the extreme T wave changes which are possible in susceptible subjects under such benign conditions as the postprandial state, respiration or minor anxiety, it is believed that T wave changes found in any routine electrocardiogram should be carefully considered as potentially physiologic. A diagnosis of heart disease on the basis of isolated T wave changes in the absence of clinical correlation or other more specific electrocardiographic findings is not justified.

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