U waves are not always pathological. If present after T wave, U waves are non-pathological. If T waves are absent in presence of U waves, there is a suspicion of underlying pathology. U waves are inversely proportional to the heart rate i.e., prolonged U waves are seen in bradycardia. Following are the cases in which U waves may be present: - Bradycardia - Hypokalemia - Hypertrophic cardiomyopathy - Hypocalcemia - Hypothermia - Elevated intracranial pressure - Hypertrophy of left ventricle - Hypomagnesemia - Digoxin - Class Ia and III anti-arrythmatic drugs - Phenothiazine Reference: https://litfl.com/u-wave-ecg-library/