Anterior T wave inversions and PE.
Last week, I described the case of a middle-aged male with a vague history of heart failure who had been having progressive shortness of breath for 4-5 days. On the day he called 911, he had been walking a short distance when he syncoped. EMS obtained an ECG:
Inverted T waves are seen in III and aVF, as well as V1-V4.
Compared with the prior ECG, the anterior T wave inversions appeared new.
Subtle S1Q3T3, but no ATWI
What can cause anterior T wave inversion (ATWI)?
There are some rare entities that show up with ATWI; e.g. ARVC. Young women can also have a benign variant, the so-called persistent juvenile T wave pattern.
But in this clinical context, we should consider two main categories: 1) myocardial ischemia, and 2) right ventricular strain.
ATWI and myocardial ischemia
Posterior STEMIs can initially appear as inverted T waves in the right-sided leads, but there is usually a degree (or more!) of ST depression in those same leads.
From http://www.ncbi.nlm.nih.gov/pubmed/22920785
On the other hand, so-call “anterior ischemia” can cause ATWI too. But this usually is more prominent in the lateral leads, with a “strain” pattern of ST depression as well.
From http://hqmeded-ecg.blogspot.com/2014/07/head-on-motor-vehicle-collision-st.html
You can also see Wellen’s syndrome in the anterior leads, but these T waves are notable for being deep and/or biphasic.
From http://hqmeded-ecg.blogspot.com/2014/06/wellens-waves-appear-and-disappear.html
Clinically...
Source: EMS 12-Lead - Category: Cardiology Authors: Brooks Walsh MD Tags: Uncategorized Source Type: research
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