Typically the normal ECG shows progression of T-wave size across the precordial leads & the T-wave in V1 is inverted or flat
A large upright T-wave in V1 can be considered normal when there is high voltage/LVH or LBBB
A new upright T-wave in V1 can be indicative of significant atherosclerotic disease
If the T-wave in V1 is larger than the T-wave in V6 have a high suspicion for myocardial disease
A new tall upright T-wave in V1 has ~84% specificity for ischemic heart disease (Barthwal)
References
Barthwal SP, Agarwal R, Sarkari NB et al. Diagnostic Significance of TI < T III and TVI > TV6 signs in ischemic heart disease . J Assoc Phys India 1993;41:26-7
