Differential Diagnosis for Chest Pain with T Wave Inversion
Single Most Likely Diagnosis
- Acute Coronary Syndrome (ACS): T wave inversion can be an early sign of ACS, including myocardial infarction (MI) or unstable angina. Even with normal initial labs, ACS is a critical condition that requires prompt evaluation and management.
Other Likely Diagnoses
- Myocarditis: Inflammation of the heart muscle can cause chest pain and ECG changes, including T wave inversion. Normal labs do not rule out myocarditis, as troponin levels may not be elevated in all cases.
- Pericarditis: Inflammation of the pericardium can cause chest pain and ECG changes. While the classic ECG finding is widespread ST elevation, T wave inversion can occur in the later stages.
- Pulmonary Embolism (PE): While not typically associated with T wave inversion, a large PE can cause ECG changes, including T wave inversion, due to right heart strain.
Do Not Miss Diagnoses
- Aortic Dissection: A life-threatening condition that can cause chest pain and ECG changes, including T wave inversion. Normal labs do not rule out aortic dissection, and a high index of suspicion is necessary.
- Cardiac Tamponade: Accumulation of fluid in the pericardial space can cause cardiac compression, leading to chest pain and ECG changes. T wave inversion can occur due to decreased cardiac output.
Rare Diagnoses
- Hypokalemia: Severe potassium deficiency can cause T wave inversion, although it is typically associated with other ECG changes, such as ST segment depression and U waves.
- Mitral Valve Prolapse: A condition where the mitral valve leaflets prolapse into the left atrium, which can cause chest pain and ECG changes, including T wave inversion.
- Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): A rare condition characterized by fibrofatty replacement of the right ventricular myocardium, which can cause ECG changes, including T wave inversion.