When you’re learning ECG interpretation, the T wave often feels like the quiet kid in the corner, not causing much trouble, not setting off alarms like wide QRS complexes or towering ST elevations. But occasionally, the T wave grows… a hump. Sometimes two humps and suddenly you’re looking at something that resembles a small camel taking a sunset stroll across your ECG tracing.
Welcome to the world of the Camel Hump T Wave.
These double-peaked T waves aren’t just a quirky shape. They can indicate serious underlying physiology and, more importantly, they can be confused with several other T wave abnormalities. As a student paramedic, recognising these patterns early will help you build confidence in your ECG reading and sharpen your clinical thinking.
Let’s break this down properly.
What Are Camel Hump T Waves?
A Camel Hump T wave is a T wave with two distinct peaks (a “bifid” or “notched” T wave).
Think of it as a T wave with a small extra bump sitting on top or slightly beside the main peak.
These humps represent altered repolarisation, usually because something is affecting the ventricles’ ability to recover smoothly.
What Causes Camel Hump T Waves?
Camel hump T waves aren’t a diagnosis themselves, they’re a clue pointing you toward the underlying problem. Common causes include:
1. Hypothermia
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One of the most classic associations.
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The notched T wave appears alongside other hypothermia features such as Osborn waves (J waves), bradycardia, and prolonged intervals.
2. CNS Events (e.g., Subarachnoid Haemorrhage)
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“Cerebral T waves” can appear in acute neurological injury.
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These can be deep, inverted, or notched depending on the severity.
3. Congenital Long QT Syndrome
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Particularly LQT2 can produce low-amplitude, notched or bifid T waves.
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May present with prolonged QTc and risk of torsades de pointes.
4. Mitral Valve Prolapse
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Often produces T wave notching in the inferior leads.
5. Ischaemia
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Early reperfusion in a STEMI may transiently produce a notched T wave.
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Think of this as the myocardium “waking back up,” but don’t rely on this finding alone.
ECG Changes You May See with Camel Hump T Waves
Alongside the notched T waves themselves, you may see:
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Prolonged QT interval
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Bradycardia (e.g., hypothermia)
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J waves / Osborn waves
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Diffuse T wave abnormalities that don’t match a coronary territory
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Variations across the leads, these aren’t always uniform
Always consider the clinical context:
Camel humps rarely turn up to the party alone.
Other T Wave Abnormalities That Can Be Confused With Camel Humps
Because ECGs love to keep student paramedics guessing, here are a few T wave patterns that might trick you into suspecting a camel where there’s really just a slightly worn-out pony.
1. Hyperkalaemia
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Tall, peaked, narrow-based T waves.
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Often symmetrical and sharp not notched.
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Think “tents,” not “camels.”
2. U Waves
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These can look like a second hump but they sit after the T wave, not on it.
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Prominent in hypokalaemia, bradycardia, or with certain medications.
3. Biphasic T Waves
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The T wave goes up and then down (or down then up) but that’s a change in direction, not two peaks.
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Classic in Wellens syndrome (V2–V3).
4. Early Repolarisation
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Can occasionally produce slightly notched J-points and quirky T wave contours, but usually has a stable pattern and benign appearance.
5. Artefact
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ECG paper plus patient movement equals all kinds of wildlife shapes.
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If it only appears in one beat: suspect artefact, not pathology.
Clinical Significance for Paramedics
Camel hump T waves are a red flag for repolarisation abnormality but not a stand-alone emergency. Their meaning depends entirely on context.
As a paramedic, think:
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Is the patient cold? (Hypothermia protocol)
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Neurological symptoms? (Think SAH or raised ICP)
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Syncopal episodes or family history of cardiac events? (Possible Long QT)
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Chest pain? (Ischaemia or reperfusion)
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Electrolyte disturbance? (Consider in dehydrated, renal patients, or those on meds)
Your ECG interpretation should always link back to the patient’s presentation not the other way around.
Summary for Student Paramedics
Camel hump T waves look unusual, but they’re a great example of how the ECG reflects underlying physiology.
Key points to remember:
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They are notched / bifid T waves with two peaks.
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Causes include hypothermia, CNS events, Long QT syndrome, mitral valve prolapse, and ischaemia.
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Don’t confuse them with U waves, hyperkalaemia peaks, biphasic T waves, or artefact.
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Context is everything always match the ECG to the patient.
If you spot a camel on your ECG, don’t panic.
Just ask yourself: “Why is it here, what is it trying to tell me, and what does this mean for my patient?”
That’s how you turn pattern recognition into clinical thinking and that’s exactly what makes a great paramedic.
