Differential Diagnosis for T Wave Inversions with Q Waves on EKG
Single Most Likely Diagnosis
- Myocardial Infarction (MI): The presence of Q waves and T wave inversions on an EKG is highly suggestive of a previous myocardial infarction. Q waves indicate necrosis of the heart muscle, while T wave inversions can signify ischemia or infarction.
Other Likely Diagnoses
- Ischemic Cardiomyopathy: This condition can result from repeated episodes of myocardial ischemia, leading to scarring and remodeling of the heart muscle, which may manifest as Q waves and T wave inversions on an EKG.
- Cardiac Sarcoidosis: Although less common, cardiac sarcoidosis can cause granulomatous inflammation leading to scarring within the heart, potentially resulting in Q waves and T wave inversions due to the disruption of normal cardiac tissue.
- Hypertrophic Cardiomyopathy: Certain patterns of hypertrophic cardiomyopathy, especially those involving the septum, can lead to abnormal EKG findings, including Q waves and T wave inversions, due to the altered architecture of the heart muscle.
Do Not Miss Diagnoses
- Pulmonary Embolism (PE): While not the most common cause of these EKG findings, a pulmonary embolism can lead to right ventricular strain, which may manifest as T wave inversions in the anterior leads. Missing this diagnosis can be fatal.
- Cardiac Tumors: Although rare, cardiac tumors (e.g., myocardial fibroma, rhabdomyoma) can cause localized damage to the heart muscle, potentially resulting in abnormal EKG patterns, including Q waves and T wave inversions.
Rare Diagnoses
- Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): A rare condition characterized by the replacement of right ventricular muscle with fibrofatty tissue, which can lead to abnormal EKG findings, including T wave inversions in the right precordial leads.
- Left Ventricular Non-Compaction: A rare cardiomyopathy characterized by the presence of excessive trabeculations in the left ventricle, which can lead to abnormal EKG findings, including Q waves and T wave inversions, due to the disorganized structure of the heart muscle.
- Myocardial Bridging: A condition where a portion of a coronary artery dives into and is surrounded by the myocardium, which can lead to ischemia and potentially result in EKG abnormalities, including T wave inversions.