Inverted T waves are upside-down. They can be normal in children. If abnormal they may be caused by ischemia, infarction, strain patterns, bundle branch blocks or raised intracranial pressure.
T waves may be inverted in III, aVL and/or V1. T waves should not be negative in I, II, V5 and V6. T inversion in V2 is common in young women and normal in 1% of young men <30.
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This ECG is from a woman in her 30s who presented with altered mental status and syncope. She was hypotensive and tachycardic.
This ECG shows sinus tachycardia with concave ST segments and domed inverted T waves V1-3, consistent with acute right heart strain caused by large bilateral Pulmonary Emboli.
This ECG is from a man in his 60s who developed hypokalemia during a complicated hospital admission including GI bleed and anaemia.
This ECG shows inverted T waves and inverted U waves with a very prolonged QT. There is subtle ST elevation in inferior and lateral leads. Troponin was elevated, echo showed regional wall motion abnormalities apical and anteriorly. Angiogram showed severe multivessel disease and an apical LAD occlusion of uncertain age. The most likely cause was either a small infarction or takotsubo.
This ECG is from a man in his 30s who presented with a week of chest pain.
This ECG shows T wave inversion in V5-6 with J point notching and a short QT interval. Echo showed global hypokinesis and mild-mod systolic dysfunction. Troponin was elevated. Angiogram was normal. The diagnosis was myocarditis.
This ECG is from a woman in her 40s who presented with intermittent chest pain on exertion over the past 2 weeks. This was the initial ECG when she was pain free.
This ECG shows an inverted T wave in III with slight ST depression V3-6. Troponins were negative. Repeat ECG showed dynamic ST segments. Angiography showed a 95% stenosis of the distal RCA.