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R on T wave in my EKG strip???
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R on T wave in my EKG strip???

I have frequent PVC's along with slightly dilated cardiomyopathy and so on. Frequent PVC's and i bought a hand-held 3 lead EKG monitor. It frequently analyzes my 30 second strips and frequently tells me "suspected R on T wave." I looked this up and read it is very dangerous, BUT can often be misread. Can someone please check the picture in the link below and tell me whether or not I am really having this? Should i call my cardiologist about these findings? Or is my EKG strip safe? Can someone explain or link to an example of R on T so i know what to look for?

http://s298.photobucket.com/albums/mm276/buttkrust/?action=view&current=ront1.jpg
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1124887_tn?1313758491
I can't confirm or rule out anything, because I'm not a doctor. But it's quite easy to conclude based on your EKG strip.

There's no R on T here as far as I can see.

The T wave is the large wave following the QRS complex. R on T is easily seen as a PVC "enlarging" the T wave, see the link below. On your EKG, the PVC is following the T wave, they are not connected.

http://www.frca.co.uk/images_main/resources/ECG/ECGresource36.jpg

This is an image of a R on T PVC.

R on T is dangerous in hearts with electrical abnormalities, as long QT syndrome. It's very uncommon in healthy people, and even less likely to be dangerous.

Always contact your doctor or the ER if you get tachycardia after a PVC, regardless of R on T.


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995271_tn?1408549100
Looks like the PVC hit right after the T wave but it's close. Your Ts have a bit of a deflection below the isometric when they finish and it looks like that's when the PVCs hit.  I have no idea what the clinical significance might be.  Talk to your cardiologist.
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1124887_tn?1313758491
I agree with itdood. Talk to your cardiologist.

Ambulatory EKG recorders are really only useful in determining the heart rhythm. Nuisances like this should be evaluated on a 12 lead EKG, and interpreted by a cardiologist.

As itdood said, there is a possibility your T-waves are biphasic, and the PVC hits quite close to the T wave. It's not necessarily dangerous, as I said, but there are two problems here:

1. We are not doctors.
2. You need a complete EKG recording.

Your cardiologist can help you with both.



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1124887_tn?1313758491
I meant "nuances".

Nuisances was something else:) I need to learn English..
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520292_tn?1232039450
I disagree, Im not a doc , but I believe it is a suspect R on T.  To be exact, it looks like  R on T occurring at the Peak of the preceding T wave but not exactly.  I would go have a cardio doc take a look at it.

Check this out

http://library.med.utah.edu/kw/ecg/mml/ecg_ront.html
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520292_tn?1232039450
either way, the clinical significance of R on T is small,  in a normal healthy heart.
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1124887_tn?1313758491
We posted the same picture :)
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520292_tn?1232039450
lol !  Didnt even notice  :P
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Avatar_m_tn
I am a Certified Cardiographic Technician, who works as a Monitor Tech in a hospital. As others has said, you should see a cardiologist.

It would be also help to have a different lead (hence a 12 lead). I do not believe this is an R on T PVC.

But here are some things that I have observed: The so called "PVC" is vary narrow, which may indicate a junctional beat, perhaps conducted with abberancy (most likely right bundle branch may still be refractory). There is no visible P wave before it. There is also what I believe is a slight Q wave right before the "PVC" which may indicate septal depolarization.

In my professional opinion, this is not an R on T pvc.
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Avatar_m_tn
" R on T" is a phenomenon which has been studied in the critical care setting of various Acute MI patients and those with Ischemic heart disease. In the context of such patients and people with a genetic disorder known as 'Brugada syndrome', R-on-T phenemenon becomes significant. In case of acute MI patients, a study has shown that out of 44 patients with R-onT PVCs, only 6  (14%) developed fatal arrhythmias like V-Tach and V-Fib. Many other studies have also revealed similar results.14% is very significant in Medical science and cannot be ignored, so it has become customary to take the R-on-T phenomenon into consideration. I don't know of any studies being done on the significance of this phenomenon in persons with normal hearts. 10 % of V-Tachs are suffered by people with normal hearts.These are known as "Idiopathic VTs". They rarely cause a sudden death and the prognosis is excellent.Normal hearts can tolerate VTs for many hours before they transform into V-fib or a Cardiac Arrest. Timely medical help and drugs like "Veramapil"  can easily control VTs.Sometimes Vagal maneoures also help. Often the VTs in normal people are Non-Sustained, which means they subside on their own within 30 seconds. Some may take longer.And emergency medical care can take care of them.
In a nutshell, benign PVCs rarely lead to R-on-T phenomenon. Even if they lead, there are 14% chances (That too in diseased hearts) of initiating a V-Tach.Even if it does, it may be a non-sustained VT.Even if it is 'Sustained' , deaths are rare and you can seek Medical help or it may subside on its own even before that. Risks are there in almost every activity that we indulge in e.g. driving a car has its own risks,Travelling by air has its own risks, so on and so forth. Put your trust in God and go on cheerfully.....hope it helps
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